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 NameAffiliationE-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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