Allogeneic hematopoietic stem cell transplantation (HSCT) could be the only curative therapy for patients with relapsed/refractory acute leukemia (RRAL). Many reports have described unmanipulated haploidentical HSCT (HID-HSCT) using high-dose antithymocyte globulin (ATG). However, the transplant outcomes of HID-HSCT using very low-dose ATG (thymoglobulin, 2-2.5 mg/kg) and methylprednisolone (mPSL, 1 mg/kg) for patients with RRAL have not been reported. We compared the outcomes of 46 patients with RRAL who underwent HID-HSCT using very low-dose ATG (thymoglobulin) and mPSL with the outcomes of 72 patients who underwent non-HID-HSCT. Patient characteristics differed regarding conditioning intensity (myeloablative; 19.6% in HID-HSCT vs. 61.1% in non-HID-HSCT, P < 0.001) and having undergone multiple HSCT (26.1% vs. 11.1%, P = 0.045). However, we found no significant differences in the 1-year overall survival (OS, 31.7% vs. 29.1%; P = 0.25), disease-free survival (DFS, 20.5% vs. 23.7%; P = 0.23), cumulative incidence of relapse (CIR, 40.0% vs. 42.8%; P = 0.92), non-relapse mortality (NRM, 39.5% vs. 33.5%; P = 0.22), or 100-day grade II-IV acute graft-versus-host disease (32.6% vs. 34.7%; P = 0.64) following HID-HSCT vs. non-HID-HSCT, respectively. Subgroup analysis stratified by disease and intensity of conditioning regimen demonstrated the same results between HID-HSCT and non-HID-HSCT. Furthermore, multivariate analysis showed that HID-HSCT was not an independent prognostic factor for OS (hazard ratio (HR) = 0.95 [95% confidence interval (CI), 0.58-1.58]), DFS (HR = 1.05 [95%CI, 0.67-1.68]), CIR (HR = 0.84 [95%CI, 0.48-1.47]), or NRM (HR = 1.28 [95%CI, 0.66-2.46]). In summary, transplant outcomes for RRAL were comparable in the HID-HSCT and non-HID-HSCT groups. HID-HSCT using very low-dose ATG and mPSL for RRAL may be a viable alternative to non-HID-HSCT.

中文翻译：

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在复发/难治性急性白血病的成人中，使用极低剂量的抗胸腺细胞球蛋白和甲基泼尼松龙进行未操纵的单倍体造血干细胞移植。

异基因造血干细胞移植（HSCT）可能是复发/难治性急性白血病（RRAL）患者的唯一治疗方法。许多报告描述了使用大剂量抗胸腺细胞球蛋白（ATG）的单倍体HSCT（HID-HSCT）。但是，尚未报道使用低剂量ATG（胸腺球蛋白，2-2.5 mg / kg）和甲基泼尼松龙（mPSL，1 mg / kg）对RRAL患者进行HID-HSCT的移植结局。我们将46例使用极低剂量ATG（胸腺球蛋白）和mPSL进行HID-HSCT的RRAL患者的结局与72例进行非HID-HSCT的患者的结局进行了比较。患者的适应性强度特征有所不同（清髓性； HID-HSCT为19.6％，非HID-HSCT为61.1％，P <0.001），并经历了多次HSCT（26.1％vs. 11.1％，P = 0.045）。然而，我们发现1年总生存率（OS，分别为31.7％和29.1％； P = 0.25），无病生存期（DFS，分别为20.5％和23.7％； P = 0.23），复发的累积发生率无显着差异（CIR，40.0％对42.8％； P = 0.92），非复发死亡率（NRM，39.5％对33.5％； P = 0.22）或100天II-IV级急性移植物抗宿主病（ HID-HSCT与非HID-HSCT后分别为32.6％和34.7％； P = 0.64）。按疾病和条件治疗强度分层的亚组分析表明，HID-HSCT和非HID-HSCT的结果相同。此外，多因素分析显示，HID-HSCT不是OS的独立预后因素（危险比（HR）= 0.95 [95％置信区间（CI），0.58-1.58]），DFS（HR = 1.05 [95％CI， 0.67-1.68]，CIR（HR = 0.84 [95％CI，0.48-1.47]）或NRM（HR = 1.28 [95％CI，0.66-2.46]）。综上所述，在HID-HSCT组和非HID-HSCT组中，RRAL的移植结局相当。使用非常低剂量的ATG和mPSL进行RRAL的HID-HSCT可能是非HID-HSCT的可行替代方案。