Journal
JOURNAL OF HEMATOLOGY & ONCOLOGY
Volume 10, Issue -, Pages -Publisher
BMC
DOI: 10.1186/s13045-017-0502-3
Keywords
Acute myeloid leukemia; Allogeneic stem cell transplantation; Minimal residual disease; Multiparameter flow cytometry; Unmanipulated haploidentical allografts
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Funding
- National High Technology Research and Development Program of China (Program 863) [2013AA020104]
- Foundation for Innovative Research Groups of the National Natural Science Foundation of China [81621001]
- National Natural Science Foundation of China [81470342]
- Key Program of National Natural Science Foundation of China [81230013]
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Background: 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. Methods: A retrospective study (n = 339) and a prospective study (n = 340) were performed. MRD was determined using multiparameter flow cytometry. Results: 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. Conclusions: 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.
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