Comparable post-relapse outcomes between haploidentical and matched related donor allogeneic stem cell...

Area of Science:

• Hematology
• Oncology
• Immunology

Background:

• Allogeneic hematological stem cell transplantation (allo-HSCT) is a curative option for hematological malignancies.
• Relapse remains a significant challenge, necessitating strategies to improve post-relapse survival (PRS).
• Donor type, including haploidentical donor (HID) and matched sibling donor (MRD), may influence outcomes after relapse.

Purpose of the Study:

• To compare post-relapse survival (PRS) between patients undergoing allo-HSCT from haploidentical donors (HID) versus matched sibling donors (MRD).
• To identify factors associated with improved PRS in patients relapsing after first allo-HSCT.
• To evaluate the safety and efficacy of donor lymphocyte infusion (DLI) in the context of HID transplantation.

Main Methods:

• Retrospective analysis of 85 patients with hematological relapse after first allo-HSCT.
• Comparison of overall survival and PRS between HID and MRD groups.
• Multivariate analysis to identify independent predictors of PRS, including DLI, relapse timing, and remission status at transplantation.

Main Results:

• Similar 3-year overall survival and PRS were observed between HID and MRD groups (P=0.913 and P=0.667, respectively).
• Higher rates of acute and chronic graft-versus-host disease (GvHD) were noted in the HID group.
• Treatment with DLI, late relapse (>1 year), and achieving first complete remission (CR) at transplantation were associated with superior PRS (P<0.05).

Conclusions:

• Post-relapse outcomes are comparable between haploidentical and matched sibling donor transplantation.
• Donor lymphocyte infusion (DLI) is a safe and effective treatment option for relapsed patients, including those after haploidentical transplantation.
• Strategies like DLI and optimizing pre-transplant conditions (late relapse, first CR) can improve survival after hematological relapse.