| Liu Shuhong,Sun Yide,Wang Jun,et al.Clinical efficacy of irradiation conditioning regimen in haploidentical hematopoietic stem cell transplantation for high-risk myeloid malignancies[J].Chinese Journal of Radiological Medicine and Protection,2025,45(5):438-445 |
| Clinical efficacy of irradiation conditioning regimen in haploidentical hematopoietic stem cell transplantation for high-risk myeloid malignancies |
| Received:November 13, 2024 |
| DOI：10.3760/cma.j.cn112271-20241113-00438 |
| KeyWords:Irradiation Haploidentical hematopoietic stem cell transplantation (Haplo-HSCT) Conditioning regimen Acute myeloid leukemia (AML) Myelodysplastic syndrome (MDS) |
| FundProject:国家重点研发计划(2023YFC2309000);北京市科技新星计划(20220484120) |
| Author Name | Affiliation | E-mail | | Liu Shuhong | Senior Department of Hematology, Fifth Medical Center, Chinese PLA General Hospital, Beijing 100071, China
Graduate School of Chinese PLA General Hospital, Beijing 100853, China | | | Sun Yide | Senior Department of Hematology, Fifth Medical Center, Chinese PLA General Hospital, Beijing 100071, China
Graduate School of Chinese PLA General Hospital, Beijing 100853, China | | | Wang Jun | Senior Department of Hematology, Fifth Medical Center, Chinese PLA General Hospital, Beijing 100071, China | | | Hu Jiangwei | Senior Department of Hematology, Fifth Medical Center, Chinese PLA General Hospital, Beijing 100071, China | | | Li Yuhang | Senior Department of Hematology, Fifth Medical Center, Chinese PLA General Hospital, Beijing 100071, China | | | Su Yongfeng | Senior Department of Hematology, Fifth Medical Center, Chinese PLA General Hospital, Beijing 100071, China | | | Liu Na | Senior Department of Hematology, Fifth Medical Center, Chinese PLA General Hospital, Beijing 100071, China | | | Qiao Zhuoqing | Senior Department of Hematology, Fifth Medical Center, Chinese PLA General Hospital, Beijing 100071, China | | | Hu Liangding | Senior Department of Hematology, Fifth Medical Center, Chinese PLA General Hospital, Beijing 100071, China | | | Xu Lei | Senior Department of Hematology, Fifth Medical Center, Chinese PLA General Hospital, Beijing 100071, China | | | Ning Hongmei | Senior Department of Hematology, Fifth Medical Center, Chinese PLA General Hospital, Beijing 100071, China
Graduate School of Chinese PLA General Hospital, Beijing 100853, China | ninghongmei72@sina.com |
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| Abstract:: |
| Objective To compare the efficacy and safety of irradiation-incorporated and chemotherapy only-based myeloablative conditioning regimens in haploidentical hematopoietic stem cell transplantation (haplo-HSCT) for patients with high-risk myeloid malignancies. Methods This study retrospectively collected clinical data from 63 high-risk acute myeloid leukemia/myelodysplastic syndrome (AML/MDS) patients who underwent haplo-HSCT at the Fifth Medical Center of the Chinese PLA General Hospital from January 2015 to December 2019. These patients were classified into the irradiation (n = 17) and chemotherapy (n = 46) groups based on different conditioning regimens. The differences between the two groups were compared in terms of hematopoietic reconstitution, cumulative incidence of acute/chronic graft-versus-host diseases (aGVHD and cGVHD), non-relapse mortality (NRM), relapse rate (RR), overall survival (OS), and disease-free survival (DFS), followed by the analysis of prognostic factors. Results The median follow-up time for the irradiation and chemotherapy groups was 78.5 and 72.3 months, respectively. The median time for neutrophil engraftment was 14.0 days in the irradiation group and 14.5 d in the chemotherapy group, and for platelet engraftment was 15.0 and 13.0 d, respectively. As a result, the two groups showed no statistically significant differences in hematopoietic reconstitution (P > 0.05). The cumulative incidence of aGVHD and cGVHD was higher in the irradiation group compared to the chemotherapy group, yet showing no statistically significant differences (P > 0.05). Specifically, the cumulative incidence of grade Ⅱ-Ⅳ aGVHD within 100 d was 29.4% and 21.7% for the irradiation and chemotherapy groups, respectively. The cumulative incidence of grade Ⅲ-Ⅳ aGVHD was 23.5% and 13.0%, respectively. The cumulative incidence of severe cGVHD within five years was 11.8% in the irradiation group and 8.7% in the chemotherapy group. In terms of long-term survival, the cumulative 5\｜year RR and NRM were 20.2% and 28.4% in the irradiation group, 5.9% and 23.9% in the chemotherapy group, respectively, showing no statistically significant differences (P > 0.05). The 5-year DFS and OS rates were 73.9% and 47.7% in the irradiation group, and 81.1% and 54.4% in the chemotherapy group, respectively, without statistically significant differences (P > 0.05). Notably, the irradiation group manifested more favorable DFS and OS survival curves compared to the chemotherapy group. The survival curves indicate that the irradiation-incorporated regimen exhibited better trends in OS, DFS, and cGVHD-free relapse-free survival (GRFS). However, multivariate analysis did not reveal that irradiation conditioning is an independent prognostic factor affecting survival [HR = 0.532 (0.163-1.735), 0.370 (0.091-1.516), 0.683 (0.248-1.882), P > 0.05]. Conclusions In haplo-HSCT for high-risk myeloid malignancies, the irradiation-incorporated conditioning regimen demonstrates lower RR and NRM, higher DFS and OS, and potentially superior survival outcomes compared to the chemotherapy only-based regimen. Therefore, the irradiation-incorporated conditioning regimen may be preferentially considered in haplo-HSCT. |
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