Abstract：
BACKGROUND: The two most noteworthy strategies for haploidentical stem cell transplantation (haplo-HSCT) are posttransplantation cyclophosphamide (PTCy) with or without thymoglobulin (ATG) and granulocyte colony stimulating factor-primed bone marrow plus peripheral blood stem cells (GIAC). We aimed to compare these approaches in patients with hematological malignancies.
METHODS: We enrolled 178 patients undergoing haplo-HSCT, including modified GIAC (mGIAC), PTCy without ATG, and PTCy with ATG.
RESULTS: The patients in the mGIAC group had the most favorable platelet and neutrophil engraftment kinetics. Although the grade III-IV acute graft-versus-host-disease (GvHD) rates were similar, those receiving mGIAC had a significantly higher extensive chronic GvHD rate. The patients receiving mGIAC had a similar cumulative incidence of relapse (CIR) to that in the patients receiving PTCy with ATG, but this was lower than that in the patients receiving PTCy without ATG. The patients receiving mGIAC had the lowest nonrelapse mortality (NRM) and the highest overall survival (OS) rates. The differences in CIR, NRM, and OS remained significant when focusing on patients with low/intermediate-risk diseases before haplo-HSCT. Intriguingly, among patients with high/very-high-risk diseases before haplo-HSCT, no differences were observed in the CIR, NRM, OS, or GvHD/relapse-free survival.
CONCLUSIONS: the mGIAC approach may yield a better outcome in Taiwanese patients with hematologic malignancies, especially for those with low/intermediate-risk diseases.
METHODS: We enrolled 178 patients undergoing haplo-HSCT, including modified GIAC (mGIAC), PTCy without ATG, and PTCy with ATG.
RESULTS: The patients in the mGIAC group had the most favorable platelet and neutrophil engraftment kinetics. Although the grade III-IV acute graft-versus-host-disease (GvHD) rates were similar, those receiving mGIAC had a significantly higher extensive chronic GvHD rate. The patients receiving mGIAC had a similar cumulative incidence of relapse (CIR) to that in the patients receiving PTCy with ATG, but this was lower than that in the patients receiving PTCy without ATG. The patients receiving mGIAC had the lowest nonrelapse mortality (NRM) and the highest overall survival (OS) rates. The differences in CIR, NRM, and OS remained significant when focusing on patients with low/intermediate-risk diseases before haplo-HSCT. Intriguingly, among patients with high/very-high-risk diseases before haplo-HSCT, no differences were observed in the CIR, NRM, OS, or GvHD/relapse-free survival.
CONCLUSIONS: the mGIAC approach may yield a better outcome in Taiwanese patients with hematologic malignancies, especially for those with low/intermediate-risk diseases.
摘要：
背景：单倍体干细胞移植（haplo-HSCT）的两个最值得注意的策略是移植后环磷酰胺（PTCy）加或不含胸腺球蛋白（ATG）和粒细胞集落刺激因子引发的骨髓加外周血干细胞（GIAC）。我们旨在比较这些方法在血液系统恶性肿瘤患者中的应用。
方法：我们招募了178名接受haplo-HSCT的患者，包括改进的GIAC(MGIAC)，不带ATG的PTCy,和ATG的PTCy。
结果：mGIAC组的患者具有最有利的血小板和中性粒细胞植入动力学。尽管III-IV级急性移植物抗宿主病（GvHD）的发生率相似，接受mGIAC的患者广泛慢性GvHD发生率明显较高.接受mGIAC的患者的累积复发率（CIR）与接受ATG的PTCy的患者相似，但这低于接受无ATG的PTCy的患者。接受mGIAC的患者的非复发死亡率（NRM）最低，总生存率（OS）最高。CIR中的差异，NRM,在haplo-HSCT之前关注低/中危疾病患者时，OS仍然显着。有趣的是，在haplo-HSCT之前患有高危/非常高危疾病的患者中，在CIR中没有观察到差异，NRM,操作系统,或GvHD/无复发生存。
结论：mGIAC方法可能在台湾恶性血液病患者中产生更好的结果，特别是对于那些低/中风险疾病。
方法：我们招募了178名接受haplo-HSCT的患者，包括改进的GIAC(MGIAC)，不带ATG的PTCy,和ATG的PTCy。
结果：mGIAC组的患者具有最有利的血小板和中性粒细胞植入动力学。尽管III-IV级急性移植物抗宿主病（GvHD）的发生率相似，接受mGIAC的患者广泛慢性GvHD发生率明显较高.接受mGIAC的患者的累积复发率（CIR）与接受ATG的PTCy的患者相似，但这低于接受无ATG的PTCy的患者。接受mGIAC的患者的非复发死亡率（NRM）最低，总生存率（OS）最高。CIR中的差异，NRM,在haplo-HSCT之前关注低/中危疾病患者时，OS仍然显着。有趣的是，在haplo-HSCT之前患有高危/非常高危疾病的患者中，在CIR中没有观察到差异，NRM,操作系统,或GvHD/无复发生存。
结论：mGIAC方法可能在台湾恶性血液病患者中产生更好的结果，特别是对于那些低/中风险疾病。
