Haploidentical allograft is superior to matched sibling donor allograft in eradicating pre-transplantation minimal residual disease of AML patients as determined by multiparameter flow cytometry: a retrospective and prospective analysis

• Published in: Journal of hematology and oncology Vol. 10; no. 1; pp. 134 - 13
• Main Authors: Chang, Ying-Jun, Wang, Yu, Liu, Yan-Rong, Xu, Lan-Ping, Zhang, Xiao-Hui, Chen, Huan, Chen, Yu-Hong, Wang, Feng-Rong, Han, Wei, Sun, Yu-Qian, Yan, Chen-Hua, Tang, Fei-Fei, Mo, Xiao-Dong, Liu, Kai-Yan, Huang, Xiao-Jun
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 04.07.2017; BioMed Central; BMC
• Subjects: Acute myelocytic leukemia; Acute myeloid leukemia; Adolescent; Adult; Allogeneic stem cell transplantation; Allografts; Allografts - metabolism; Allografts - transplantation; Bone marrow; Care and treatment; Chemotherapy; Child; Child, Preschool; Diagnosis; Disease prevention; Disease-Free Survival; Female; Flow Cytometry; Graft vs Host Disease - etiology; Graft vs Host Disease - genetics; Haploidy; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Histocompatibility antigen HLA; HLA Antigens - genetics; Homografts; Humans; Leukemia; Leukemia, Myeloid, Acute - genetics; Leukemia, Myeloid, Acute - therapy; Lymphocytes; Male; Middle Aged; Minimal residual disease; Multiparameter flow cytometry; Multivariate analysis; Neoplasm, Residual - genetics; Neoplasm, Residual - therapy; Oncology; Physiological aspects; Prospective Studies; Retrospective Studies; Siblings; Stem cell transplantation; Stem cells; Survival Analysis; Tissue Donors; Transplantation; Transplantation, Homologous - adverse effects; Transplantation, Homologous - methods; Transplants & implants; Treatment Outcome; Unmanipulated haploidentical allografts; Young Adult; China; Minimal residual disease; Multiparameter flow cytometry; Allogeneic stem cell transplantation; Acute myeloid leukemia; Unmanipulated haploidentical allografts
• ISSN: 1756-8722; 1756-8722
• DOI: 10.1186/s13045-017-0502-3

This study compared the effects of pre-transplantation minimal residual disease (pre-MRD) on outcomes in AML patients who underwent human leukocyte antigen-matched sibling donor transplantation (MSDT) or who received unmanipulated haploidentical allografts. A retrospective study (n = 339) and a prospective study (n = 340) were performed. MRD was determined using multiparameter flow cytometry. Either after retrospective or prospective analysis, patients with negative pre-MRD (pre-MRDneg) had a lower incidence of relapse than those with positive pre-MRD (pre-MRDpos) in MSDT settings (P < 0.001 for all), but relapse was comparable in Haplo-SCT settings for patients with pre-MRDneg versus pre-MRDpos (P = 0.866 and 0.161, respectively). In either the retrospective (n = 65) or the prospective study (n = 76), pre-MRDpos subjects receiving Haplo-SCT experienced a lower incidence of relapse than those who underwent MSDT (P < 0.001 and p = 0.017, respectively). Of the patients with pre-MRDpos in either the total (n = 141) or the subgroup excluding cases which received donor lymphocyte infusion (DLI; n = 105), those who underwent MSDT had a higher incidence of relapse than those receiving haplo-SCT (P < 0.01 for all). Multivariate analysis showed that, for pre-MRDpos cases, haplo-SCT was associated with a low incidence of relapse and with better LFS and OS in either retrospective group, prospective group, combination groups, or subgroup not including cases which received DLI. The results indicated that, for pre-MRD-positive AML patients, haplo-SCT was associated with lower incidence of relapse and better survival, suggesting a stronger anti-leukemia effect.