Comparison of Outcomes of Haploidentical Peripheral Blood Stem Cell Transplantation Supported by Third-Party Cord Blood Versus Human Leukocyte Antigen-Matched Sibling Peripheral Blood Stem Cell Transplantation in Hematologic Malignancy Patients

Abstract

Recent studies have shown that haploidentical hematopoietic stem cell transplantation supported by third-party cord blood (haplo-cord-HSCT) results in rapid hematopoietic recovery, low incidences of graft-versus-host disease (GVHD), and relapse of hematologic malignancies. However, few reports on haploidentical peripheral blood stem cell transplantation supported by third-party cord blood (haplo-cord-PBSCT) have been published. To evaluate the outcomes of patients who underwent haplo-cord-PBSCT or human leukocyte antigen (HLA)-matched sibling donor peripheral blood stem cell transplantation (MSD-PBSCT), we retrospectively reviewed the clinical data of patients with hematologic malignancies who underwent haplo-cord-PBSCT (n = 93) or MSD-PBSCT (n = 72) in our hospital from March 2017 to December 2020. In the haplo-cord-PBSCT and MSD-PBSCT groups, the median time for neutrophil and platelet engraftment was 13 vs. 12 days (p = 0.07) and 16 vs. 13 days (p = 0.06), respectively. The 30-day cumulative incidences of neutrophil engraftment were 100.0% and 98.6% (p = 0.12). The 100-day cumulative incidences of platelet engraftment were 96.8% and 98.6% (p = 0.01). The 100-day cumulative incidences of grade II-IV and grade III-IV acute GVHD were 29.1% vs. 23.6% (p = 0.42) and 9.7% vs. 4.2% (p = 0.18). The cumulative incidences of total and moderate/severe chronic GVHD at 1 year were 26.5% vs. 17.4% and 8.1% vs. 4.5%, respectively, and at 3 years were 34.7% vs. 34.3% (p = 0.60) and 13.6% vs. 10.6% (p = 0.49), respectively. The cumulative incidences of relapse at 1 year were 9.3% and 7.2% and at 3 years were 17.0% and 17.0% (p = 0.98). Non-relapse mortality (NRM) at 1 year was 14.6% and 8.6% and at 3 years was 17.4% and 8.6% (p = 0.13) in two groups. The probabilities of overall survival (OS), disease-free survival (DFS), and GVHD-free/relapse-free survival (GRFS) at 1 year were 81.7% vs. 88.6%, 76.1% vs. 84.2%, and 71.7% vs. 79.7%, respectively, and at 3 years were 78.7% vs. 79.0%, 65.6% vs. 74.4%, and 55.5% vs. 63.6%, respectively, in the corresponding group, p > 0.05. In conclusion, for patients with acute myeloid leukemia/myelodysplastic syndrome (AML/MDS) and acute lymphoid leukemia (ALL), haplo-cord-PBSCT results in similar outcomes compared with MSD-PBSCT, and it may be a valid alternative transplantation method.

Keywords: HLA-matched sibling donor; cord blood; haploidentical donor; hematologic malignancy; peripheral blood; stem cell transplantation.

Figure 1

Assessment of hematopoietic recovery after transplantation in haplo-cord group and MSD group: (A) cumulative incidence of neutrophil engraftment and (B) cumulative incidence of platelet engraftment. MSD, matched sibling donor.

Figure 2

Assessment of cumulative incidence of aGVHD in haplo-cord group and MSD group: (A) grade II–IV aGVHD and (B) grade III–IV aGVHD. aGVHD, acute graft-versus-host disease; MSD, matched sibling donor.

Figure 3

Assessment of cumulative incidence of cGVHD in haplo-cord group and MSD group: (A) all grades of cGVHD and (B) cGVHD (moderate/severe). cGVHD, chronic graft-versus-host disease; MSD, matched sibling donor.

Figure 4

Comparisons of outcomes between the haplo-cord group and the MSD group: (A) cumulative incidence of NRM and (B) cumulative incidence of relapse. MSD, matched sibling donor; NRM, non-relapse mortality.

Figure 5

Comparisons of survival rates in haplo-cord group and MSD group. (A) Overall survival (OS). (B) Disease-free survival (DFS). (C) GVHD/relapse-free survival (GRFS). MSD, matched sibling donor; GVHD, graft-versus-host disease.