Haploidentical hematopoietic SCT may be superior to conventional consolidation/maintenance chemotherapy as post-remission therapy for high-risk adult ALL

Only 30% of high-risk adult ALL patients in their first complete remission (CR1) are able to receive an HLA-matched sibling stem cell transplant. The role of haploidentical hematopoietic SCT (haplo-HSCT) in post-remission therapy is not well established. Recently, we developed a novel protocol for unmanipulated haploidentical transplantation. In this study, we compared haplo-HSCT with conventional consolidation and maintenance chemotherapy in adult high-risk ALL patients. Between January 2000 and December 2012, 104 patients received conventional chemotherapy and 79 patients received haplo-HSCT. Patients who underwent haplo-HSCT had significantly improved 3-year OS (72.5% vs 26.6%; P < 0.001), 3-year disease-free survival (DFS) (63.9% vs 21.1%; P < 0.001) and 3-year relapse (18.7% vs 60.5%; P < 0.001) rates. The non-relapse mortality (NRM) rate was not different between patients treated with haplo-HSCT vs chemotherapy (19.2% vs 14.4%; P = 0.80). In multivariate analysis, the only factor associated with improved OS, better DFS and low risk of relapse was haplo-HSCT. The only factor associated with high NRM was enrollment before 2006. In conclusion, haplo-HSCT may be an option for adults with high-risk ALL in CR1 who do not have an HLA-matched donor.