Haploidentical Unmanipulated G-CSF-Primed Peripheral Blood Stem Cell Transplantation for Patients with High-Risk Hematologic Malignancies
Authors: Liu Dai-Hong , Yu Li , Huang Wenrong , Dou Liping , Li Honghua , Gao Chunji , Bo Jian , Li Fei , Wang Lili 
Published: October 2019

Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HCT) is an effective, even curative, treatment for patients with high-risk hematologic malignancies. Transplantation from haploidentical donors (haplo-HCT) has been applied for the treatment of hematologic malignancies within the past 2 decades. Bone marrow (BM), G-CSF-primed peripheral blood stem cells (PBSCs), G-CSF-primed BM (G-BM) or the combination of PBSCs and G-BM can serve as stem cell sources for allo-HCT. The optimal source of stem cells in cases of haplo-HCT without ex vivo TCD under myeloablative conditioning is not yet clear. Therefore, we initiated a study of unmanipulated haplo-HCT from PBSCs (haplo-PBSCT) for the treatment of high-risk hematologic malignancies. In this report, we analyzed 89 adult patients who received consecutive haplo-PBSCT to evaluate the efficacy and safety of this transplantation procedure.
PATIENTS AND METHODS
Eighty-nine patients received consecutive haploidentical allo-PBSCT between July, 2007 ¨C June, 2014 at the Chinese PLA General Hospital, Beijing, China (Table 1). PBSCs were freshly isolated and infused into the recipients. The conditioning regimen consisted of Bu (3.2 mg.kg-1.d-1 intravenously, days -10 to -8), Carmustine, 250 mg.m-2, day -5), cytarabine (4 g.m-2.d-1, days -7 to -6), cyclophosphamide (60mg kg-1.d-1, days -4 to -3), and ATG (Thymoglobuline, rabbit; 2.5 mg.kg-1.d-1, days -5 to -2). All transplant recipients received CsA, mycophenolate mofetil, and short-term methotrexate for GVHD prophylaxis.
"High-risk'' hematologic malignancies were defined as: 1) AL with the [t(9;22)(q34;q11)], Flt3-ITD mutation, mixed lineage leukemia genes and complex cytogenetics regardless of disease stage; 2) AML-CR1 after 3 or more cycles of induction, ALL-CR1 after 4 weeks of induction or AL-CR1 with positive MRD after 2 cycles of consolidation; 3) AL beyond CR2 or in non-remission (NR) regardless of cytogenetics, or CML beyond CP1; and 4) T cell lymphoblastic lymphoma in CR and T cell lymphoma resistant to chemotherapy or autologous transplantation. The endpoint of the last follow-up for all surviving patients was January 31, 2015.
RESULTS
Sustained myeloid engraftment with full donor chimerism was achieved in 89 patients (100%) at a median of 16 (10 - 26) days. Eighty patients (89.9%) achieved platelet recovery in a median of 28 (10 - 207) days. The occurrence of GVHD was showed in Fig 1.
The 3-year of cumulative incidence of transplant-related mortality was 23.4% ± 5.4%. Non-remission status prior to transplant was found to be significantly correlated with relapse (P = 0.006, odds ratio [OR] = 3.17), leukemia-free survival (P = 0.013, OR = 2.48) (Fig. 2) and overall survival (P = 0.03, OR = 2.27).
CONCLUSION
The results described rapid and complete neutrophil engraftment, a low incidence of grade 3-4 GVHD and promising survival in patients with high-risk hematologic malignancies. It demonstrated the reliability of G-CSF-primed PBSCs as a graft source in unmanipulated haplo-HCT under myeloablative conditioning.
Table 1. Patient and donor characteristics Cases % Gender, n (%) Male 69 77.5 Age, y, median(range) Patient <46 y, n (%) 28(6-59) Donor >40 y, n (%) 38(9-61) Hematologic malignancy, n (%) AML 51 57.3 CR1 CR2* 23 3 NR*/beyond CR2 23/1 ALL 20 22.5 CR1 CR2 10 7 NR 3 CML 5 5.6 CP1* 2 AP/CP2 1/2 Lymphoma 13 14.6 CR 5 Resistant 8 Donor/recipient relationship, n (%) Parent 47 52.8 Sibling 26 29.2 Child 12 13.5 Lateral relative 4 4.5 No. of HLA antigens (A/B/DR) mismatched, n(%) 1 18 20.2 2 25 28.1 3 46 51.7 Second HCT 9 10.1 Graft: MNC (108/kg) 11.04 (5.64-36.46) CD34+ (106/kg) 5.83 (2-23.73)
Figure 1. Acute and chronic GVHD. (A) CI (Cumulative Incidence) of grade 2-4 (continuous line) and grade 3-4 (dotted line) acute GVHD. (B) CI of total (continuous line) and moderate to severe (dotted line) chronic GVHD. Figure 1. Acute and chronic GVHD. (A) CI (Cumulative Incidence) of grade 2-4 (continuous line) and grade 3-4 (dotted line) acute GVHD. (B) CI of total (continuous line) and moderate to severe (dotted line) chronic GVHD. Figure 2. Disease-free survival according to disease status. Figure 2. Disease-free survival according to disease status.

Disclosures
No relevant conflicts of interest to declare.