Haploidentical allograft is superior to matched sibling donor allograft in eradicating pre-transplantation minimal residual disease of AML patients as determined by multiparameter flow cytometry: a retrospective and prospective analysis

J Hematol Oncol. 2017 Jul 4;10(1):134. doi: 10.1186/s13045-017-0502-3.

Abstract

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.

Keywords: Acute myeloid leukemia; Allogeneic stem cell transplantation; Minimal residual disease; Multiparameter flow cytometry; Unmanipulated haploidentical allografts.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Allografts / metabolism
  • Allografts / transplantation
  • Child
  • Child, Preschool
  • Disease-Free Survival
  • Female
  • Flow Cytometry
  • Graft vs Host Disease / etiology*
  • Graft vs Host Disease / genetics
  • HLA Antigens / genetics*
  • Haploidy
  • Hematopoietic Stem Cell Transplantation / adverse effects
  • Hematopoietic Stem Cell Transplantation / methods*
  • Humans
  • Leukemia, Myeloid, Acute / genetics
  • Leukemia, Myeloid, Acute / therapy*
  • Male
  • Middle Aged
  • Neoplasm, Residual / genetics
  • Neoplasm, Residual / therapy*
  • Prospective Studies
  • Retrospective Studies
  • Siblings
  • Survival Analysis
  • Tissue Donors*
  • Transplantation, Homologous / adverse effects
  • Transplantation, Homologous / methods
  • Treatment Outcome
  • Young Adult

Substances

  • HLA Antigens