对于缺乏匹配供体的高风险急性淋巴细胞白血病（ALL）患者，不匹配的无关供体（MMUD）和单倍体（haplo）移植都是有效的选择。
该研究比较了2010-2020年接受9/10MMUD与单倍体移植联合移植后环磷酰胺（PTCy）作为移植物抗宿主病（GVHD）预防的成年ALL完全缓解（CR）患者的结局。
该研究包括781名患者（MMUD，103；haplo，678).中位年龄为40岁（19-73岁）和38岁（18-75岁），分别（p=.51）。向PTCy中添加的最常见的免疫抑制剂是霉酚酸酯（MMF）/环孢菌素A和MMF/他克莫司。体内T细胞耗竭（抗胸腺细胞球蛋白）被给予21％和8％的移植，分别（p<0.0001）。中性粒细胞(绝对中性粒细胞计数>0.5×109/L)恢复分别为97.1%和96.7%(p=1)和MMUD和haplo,分别。MMUD和haplo之间的非复发死亡率和复发发生率没有显着差异，风险比(HR)=1.45(95%置信区间[CI]，0.81-2.62；p=.21)和HR=0.81(95%CI，0.52-1.28，p=.38)，分别。用于无白血病生存的HR，总生存率,无GVHD，无复发生存率分别为,HR=1.05（95%CI，0.73-1.50，p=.8），HR=1.17（95%CI，0.77-1.76，p=0.46），与MMUD相比，haplo的HR=1.07(95%CI，0.78-1.46，p=.7)。急性（a）GVHD2-4级明显较高，HR=1.73（95%CI，1.08-2.76，p=0.023），而aGVHD3-4级和慢性GVHD在两个移植组之间没有显着差异。
对于所有CR患者，采用基于PTCy的GVHD预防的MMUD和单倍移植的结果相似，除了haplo移植的aGVHD发病率较高。
Both mismatched unrelated donor (MMUD) and haploidentical (haplo) transplantation are valid options in patients with high-risk acute lymphoblastic leukemia (ALL) lacking a matched donor.
The study compared the outcomes of adult patients with ALL in complete remission (CR) who underwent 9/10 MMUD versus haplo transplantation with posttransplant cyclophosphamide (PTCy) as graft-vs-host disease (GVHD) prophylaxis in 2010-2020.
The study included 781 patients (MMUD, 103; haplo, 678). The median age was 40 (19-73) and 38 (18-75) years, respectively (p = .51). The most frequent immunosuppression agents added to PTCy were mycophenolate mofetil (MMF)/cyclosporine A and MMF/tacrolimus. In vivo T-cell depletion (anti-thymocyte globulin) was administered to 21% and 8% of the transplants, respectively (p < .0001). Neutrophil (absolute neutrophil count >0.5 × 109 /L) recovery was achieved in 97.1% versus 96.7% versus (p = 1) in MMUD and haplo, respectively. Nonrelapse mortality and relapse incidence were not significantly different between MMUD and haplo, hazard ratio (HR) = 1.45 (95% confidence interval [CI], 0.81-2.62; p = .21) and HR = 0.81 (95% CI, 0.52-1.28, p = .38), respectively. HRs for leukemia-free survival, overall survival, and GVHD-free, relapse-free survival were respectively, HR = 1.05 (95% CI, 0.73-1.50, p = .8), HR = 1.17 (95% CI, 0.77-1.76, p = .46), and HR = 1.07 (95% CI, 0.78-1.46, p = .7) for haplo compared to MMUD. Acute (a)GVHD grade 2-4 was significantly higher with haplo, HR = 1.73 (95% CI, 1.08-2.76, p = .023), whereas aGVHD grade 3-4 and chronic GVHD did not differ significantly between the two transplant groups.
Outcomes of MMUD and haplo transplants with PTCy-based GVHD prophylaxis for ALL patients in CR are similar, apart from a higher incidence of aGVHD with haplo transplants.
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