Comparison of Therapeutic Effect between Related Donor and Unrelated Donor Allogeneic Hematopoietic Stem Cell Transplantation (allo-HSCT) in the Treatment of Leukemia.

Abstract

Objective : To compare the effect for leukemia between related donor hematopoietic stem cell transplantation (RD-HSCT) and unrelated donor hematopoietic stem cell transplantation (URD-HSCT).Methods: 115 patients received allo-HSCT, of whom 68 received RD-HSCT and 47 received URD-HSCT. All patients are HLA serologically matched. Total body irradiation (TBI) plus cyclophosphamide (CTX) was adopted in 56 cases and modified BuCY conditioning regimen (busulfan, Ara-C, Cyclophosphamide) in 59 cases. T and B cell reconstitution at different time points was assayed by flow cytometer in one year after transplantation. GVHD and nonage infection are observed after transplantation. The diference of haematopoietic and immunological reconstitution between the two groups are estimated with Independent-Samples T test. Kaplan-Meier survival analysis model is used to estimate the overall survival and the disease-free survival (DFS) in two groups.Results: The time in WBC>1.0×109/L are +13.09±2.39 and +16.28±3.01d(P=0.003), the time in BPC>20×109/L are +14.91±6.62 and +20.21±7.29d(P=0.042), respectively, in related donor bone marrow transplantation (RD-BMT) and unrelated donor bone marrow transplantation (URD-BMT). The time in WBC>1.0×109/L are +12.47±2.96 and +13.13±4.09d(P=0.488), the time in BPC>20×109/L are +12.16±4.24 and +15.67±7.12d(P=0.020), respectively, in related donor peripheral blood stem cell transplantation (RD-PBSCT) and unrelated donor peripheral blood stem cell transplantation (URD-PBSCT). The reconstitution of CD4+CD3+ at 1, 3, 6, 9, 12months and CD45RA+CD4+ at 1 month, and CD8+CD3+ at 3 months were different significantly between RD-HSCT and URD-HSCT(P value was 0.001, 0.017, 0.029, 0.041, 0.015, 0.015, 0.043, respectively). The incidence of II~IV°acute GVHD(aGVHD), chronic GVHD(cGVHD) and the lethality of GVHD are 45.45% and 52.27%(P=0.560), 45.31% and 63.16%(P=0.102), 6.06% and 15.91%(P=0.112), respectively, in RD-HSCT and URD-HSCT groups. The relapse rate are 18.18% and 11.36%(P=0.424), respectively, in RD-HSCT and URD-HSCT groups. The incidence of nonage infection are 42.42% and 47.73% (P=0.696), respectively, in RD-HSCT and URD-HSCT groups.The overall survival and the disease-free survival rate at three-year were 67.80±6.90% and 61.60±7.70%(P=0.133), 62.30±6.90% and 56.80±7.90%(P=0.177), respectively, in RD-HSCT and URD-HSCT groups.Conclusion The therapeutic effect for leukemia is not different between RD-HSCT and URD-HSCT.