Optimizing conditioning regimen with low-dose irradiation or busulfan enables the outcome of transplantation from a 6-7/8 HLA-matched donor comparable to that from an 8/8 HLA-matched unrelated donor in severe aplastic anemia patients under 40 years

Xia Qin¹, Yi-Ping Zhu², Cheng-Juan Luo¹, Ming Zhou³, Ke Huang⁴, Chun Chen⁴, Wei-Ping Zhang⁵, Yuan Sun⁶, Rong-Mu Luo⁷, Xiang-Feng Tang⁸, Ting Yang⁹, Xian-Min Song¹⁰, Shao-Yan Hu¹¹, Zi-Min Sun¹², Jiong Hu¹³, Shun-Qing Wang¹⁴, Jing Chen¹⁵

Affiliations

¹ Department of Hematology and Oncology, National Children's Medical Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai, 200127, China.
² Department of Pediatric Hematology and Oncology, West China Second University Hospital/West China Women and Children's Hospital, Sichuan University, Chengdu, China.
³ Department of Hematology, Guangzhou First People's Hospital , School of Medicine, South China University of Technology, 1 Panfu Road, Guangzhou, 510180, Guangdong, China.
⁴ Department of Pediatric Hematology and Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
⁵ Department of Hematology, Changhai Hospital, Navy Military Medical University, Shanghai, China.
⁶ Department of Hematology and Oncology, Beijing JingDu Children's Hospital, Beijing, China.
⁷ Department of Hematology and Oncology, BaYi Children's Hospital, The Seventh Medical Center of PLA General Hospital, Beijing, China.
⁸ Department of Pediatric Hematology and Oncology, The Sixth Medical Center of PLA General Hospital, Beijing, China.
⁹ Department of Hematology, Fujian Medical University Union Hospital, Fuzhou, China.
¹⁰ Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹¹ Department of Hematology and Oncology, Children's Hospital of Soochow University, Soochow, China.
¹² Department of Hematology, Anhui Provincial Hospital, University of Science and Technology of China, Hefei, China.
¹³ Department of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹⁴ Department of Hematology, Guangzhou First People's Hospital , School of Medicine, South China University of Technology, 1 Panfu Road, Guangzhou, 510180, Guangdong, China. eywangshq@scut.edu.cn.
¹⁵ Department of Hematology and Oncology, National Children's Medical Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai, 200127, China. chenjing@scmc.com.cn.

PMID: 33988738
DOI: 10.1007/s00277-021-04540-w

Comparative Study

Optimizing conditioning regimen with low-dose irradiation or busulfan enables the outcome of transplantation from a 6-7/8 HLA-matched donor comparable to that from an 8/8 HLA-matched unrelated donor in severe aplastic anemia patients under 40 years

Xia Qin et al. Ann Hematol. 2021 Sep.

. 2021 Sep;100(9):2363-2373.

doi: 10.1007/s00277-021-04540-w. Epub 2021 May 14.

Authors

Affiliations

¹ Department of Hematology and Oncology, National Children's Medical Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai, 200127, China.
² Department of Pediatric Hematology and Oncology, West China Second University Hospital/West China Women and Children's Hospital, Sichuan University, Chengdu, China.
³ Department of Hematology, Guangzhou First People's Hospital , School of Medicine, South China University of Technology, 1 Panfu Road, Guangzhou, 510180, Guangdong, China.
⁴ Department of Pediatric Hematology and Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
⁵ Department of Hematology, Changhai Hospital, Navy Military Medical University, Shanghai, China.
⁶ Department of Hematology and Oncology, Beijing JingDu Children's Hospital, Beijing, China.
⁷ Department of Hematology and Oncology, BaYi Children's Hospital, The Seventh Medical Center of PLA General Hospital, Beijing, China.
⁸ Department of Pediatric Hematology and Oncology, The Sixth Medical Center of PLA General Hospital, Beijing, China.
⁹ Department of Hematology, Fujian Medical University Union Hospital, Fuzhou, China.
¹⁰ Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹¹ Department of Hematology and Oncology, Children's Hospital of Soochow University, Soochow, China.
¹² Department of Hematology, Anhui Provincial Hospital, University of Science and Technology of China, Hefei, China.
¹³ Department of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹⁴ Department of Hematology, Guangzhou First People's Hospital , School of Medicine, South China University of Technology, 1 Panfu Road, Guangzhou, 510180, Guangdong, China. eywangshq@scut.edu.cn.
¹⁵ Department of Hematology and Oncology, National Children's Medical Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai, 200127, China. chenjing@scmc.com.cn.

PMID: 33988738
DOI: 10.1007/s00277-021-04540-w

Abstract

With the dramatic improvements in outcomes following alternative donor hematopoietic stem cell transplantation (HSCT), interest in the use of alternative donors in severe aplastic anemia (SAA) is increasing. We conducted a multicenter prospective study to explore the efficiency and safety of upfront HSCT from a 6-8/8 HLA-matched unrelated donor (MUD) or 6-7/8 HLA-matched related donor (MRD) in acquired SAA patients under 40 years. Between August 2014 and July 2017, 115 patients were enrolled, including 48 (41.7%) patients receiving grafts from an 8/8 MUD, 25 (21.7%) from a 6-7/8 MRD, and 42 (36.5%) from a 6-7/8 MUD. The incidence of grade II-IV acute graft-versus-host disease (GVHD) was higher in the 6-7/8 MUD group than in the 8/8 MUD group (42.9% vs. 12.8%, P=0.001). The corresponding incidence in the 6-7/8 MRD group was comparable to that in the 8/8 MUD group (21.7% vs. 12.8%, P=0.332). There was no significant difference in the incidence of chronic GVHD (24.3%, 13.6%, and 17.9%, P=0.676), graft failure (2.4%, 8.0%, and 6.3%, P=0.551), overall survival (85.7%, 96.0%, and 87.5%, P=0.424), and failure-free survival (83.3%, 88.0%, and 83.3%, P=0.885) among the three groups (6-7/8 MUD, 6-7/8 MRD, and 8/8 MUD). In multivariate analysis, conditioning regimen without low-dose irradiation or busulfan was associated with an inferior failure-free survival (HR=2.973, P=0.042). In conclusion, after an intensified conditioning regimen with additional low-dose irradiation or busulfan, the outcome of HSCT from a 6-7/8 MRD or 6-7/8 MUD is comparable to that from an 8/8 MUD.

Keywords: Allogeneic hematopoietic stem cell transplantation; Alternative donor; Aplastic anemia; Conditioning regimen.

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References

1. Killick SB, Bown N, Cavenagh J, Dokal I, Foukaneli T, Hill A, Hillmen P, Ireland R, Kulasekararaj A, Mufti G, Snowden JA, Samarasinghe S, Wood A, Marsh JC, British Society for Standards in H (2016) Guidelines for the diagnosis and management of adult aplastic anaemia. Br J Haematol 172(2):187–207. https://doi.org/10.1111/bjh.13853 - DOI - PubMed
1. Young NS (2018) Aplastic anemia. N Engl J Med 379(17):1643–1656. https://doi.org/10.1056/NEJMra1413485 - DOI - PubMed - PMC
1. Bacigalupo A (2017) How I treat acquired aplastic anemia. Blood 129(11):1428–1436. https://doi.org/10.1182/blood-2016-08-693481 - DOI - PubMed
1. Tichelli A, Schrezenmeier H, Socie G, Marsh J, Bacigalupo A, Duhrsen U, Franzke A, Hallek M, Thiel E, Wilhelm M, Hochsmann B, Barrois A, Champion K, Passweg JR (2011) A randomized controlled study in patients with newly diagnosed severe aplastic anemia receiving antithymocyte globulin (ATG), cyclosporine, with or without G-CSF: a study of the SAA Working Party of the European Group for Blood and Marrow Transplantation. Blood 117(17):4434–4441. https://doi.org/10.1182/blood-2010-08-304071 - DOI - PubMed
1. Marsh JC, Bacigalupo A, Schrezenmeier H, Tichelli A, Risitano AM, Passweg JR, Killick SB, Warren AJ, Foukaneli T, Aljurf M, Al-Zahrani HA, Hochsmann B, Schafhausen P, Roth A, Franzke A, Brummendorf TH, Dufour C, Oneto R, Sedgwick P, Barrois A, Kordasti S, Elebute MO, Mufti GJ, Socie G, European B, Marrow Transplant Group Severe Aplastic Anaemia Working P (2012) Prospective study of rabbit antithymocyte globulin and cyclosporine for aplastic anemia from the EBMT Severe Aplastic Anaemia Working Party. Blood 119(23):5391–5396. https://doi.org/10.1182/blood-2012-02-407684 - DOI - PubMed

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Optimizing conditioning regimen with low-dose irradiation or busulfan enables the outcome of transplantation from a 6-7/8 HLA-matched donor comparable to that from an 8/8 HLA-matched unrelated donor in severe aplastic anemia patients under 40 years

Affiliations

Optimizing conditioning regimen with low-dose irradiation or busulfan enables the outcome of transplantation from a 6-7/8 HLA-matched donor comparable to that from an 8/8 HLA-matched unrelated donor in severe aplastic anemia patients under 40 years

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