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Reduced-intensity conditioning (RIC) regimens allogeneic hematopoietic stem cell transplantation (HSCT) was developed for older patients or those with poor functional status. Haploidentical donor was appropriate alternative donor for patients without matched donors or patients with emergency disease state. However, there was few studies report the outcomes of RIC regimen of anti-thymocyte globulin (ATG) based haploidentical HSCT. The selection of the appropriate RIC regimen based on age and comorbidities in ATG-based haploidentical HSCT remains poorly described. To investigate the safety and efficacy of RIC regimen ATG-based haploidentical HSCT in older or unfit patients. Additionally, to explore the potential factors that impact the prognosis of RIC regimen of ATG-based haploidentical HSCT. We included a retrospective cohort of 63 patients with hematologic malignant diseases who underwent their first RIC haploidentical HSCT from November 2016 to June 2022 at our institutions. The conditioning regimen involved fludarabine (Flu) 30 mg/m²/kg 6 days combined with busulfan 3.2 mg/kg 2 days (Bu2) or 3 days (Bu3). ATG-Fresenius (ATG-F) was administered 10 mg/kg in total, ATG-thymoglobulin (ATG-T) was administered 6 mg/kg in total. The median age of patients in the entire cohort was 60 (32–67) years with a median follow-up of 496 (83–2182) days. There were 29 patients with AML, 20 patients with MDS, and 14 patients with ALL. A total of 32 patients underwent Bu2 RIC haplo-HSCT and 31 patients were treated with Bu3 RIC haplo-HSCT. The 2-year overall survival (OS) and 2-year disease-free survival (DFS) in whole cohort were 67.7% (95% confidence interval [CI], 53.8 − 85.1%) and 61.4% (95% CI, 48.8 − 77.3%) respectively. The cumulative incidence rates of grades II to IV and grades III to IV acute graft-versus-host disease (aGVHD) in whole cohort were 15.8% (95% CI, 4.8 − 19.6%) and 9.7% (95% CI, 0.0 − 11.8%) respectively. The 2-year cumulative incidence of chronic GVHD was 34.0% (95% CI, 18.9 − 46.3%). The 2-year cumulative incidence rates of relapse (IR) and non-relapse mortality (NRM) rates in whole cohort were 27.5% (95% CI, 14.5 − 33.7%) and 11.6% (95% CI, 2.2 − 21.9%) respectively. The probability of 2-year OS were 60.2% (95% CI:42.5-85.3%) in Bu2 and 85.5%(95% CI:73.0-100%) in Bu3 group respectively(P = 0.150). The probability of 2-year DFS were 49.7% (95% CI:33.0-74.8%) in Bu2 and 72.6% (95% CI:55.5-95.5%) in Bu3 group respectively (P = 0.045). The 2-year IR of Bu2 group was significantly higher than Bu3 group (P = 0.045). However, the 2-year NRM were not significantly different between Bu2 and Bu3 group(P > 0.05). In multivariable analysis, RIC regimen of Bu3 had superior OS and DFS than Bu2 group respectively [HR 0.42, 95% CI 0.18–0.98; P = 0.044; HR 0.34, 95% CI 0.14–0.86; P = 0.022]. Besides, RIC regimen of Bu3 had lower IR than Bu2 group [HR 0.34, 95% CI 0.13–0.89; P = 0.029]. The RIC regimen of ATG-based haploidentical HSCT is a safe and effective treatment option for patients who are older or have poor functional status. In particular, a relatively high-intensity pre-treatment regimen consisting of Bu achieves significant improvements in OS and DFS, thus providing more favorable post-transplantation clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Although the prognosis of Philadelphia‐positive acute lymphoblastic leukemia (Ph+ ALL) has improved with the introduction of tyrosine kinase inhibitors (TKIs) and stem cell transplantation, prevention of relapse after transplantation remains a concern. The aim of this study was to compare the impact of TKI prophylaxis with imatinib and dasatinib on long‐term outcomes after transplantation. Methods: Patients with Ph+ ALL who underwent allogeneic hematopoietic stem cell transplantation (allo‐HSCT) at first complete remission (CR1) and received TKI prophylaxis after allo‐HSCT were included in this retrospective analysis. Two cohorts were established based on the choice of TKI prophylaxis: the imatinib (Ima) and dasatinib (Das) cohorts. The survival and safety outcomes of these cohorts were compared. Results: Ninety‐one patients in the Ima cohort and 50 in the Das cohort were included. After a median follow‐up of 50.6 months, the 5‐year cumulative incidence of relapse, nonrelapse mortality rate, and overall survival in the Ima and Das cohorts were 16.1% and 12.5%, 5.2% and 9.8%, and 86.5% and 77.6%, respectively, with no statistical differences. The cumulative incidence of mild chronic graft‐versus‐host disease was higher in the Das cohort. The most common adverse event was neutropenia (64.7% vs. 69.5%). The Das cohort had a higher incidence of gastrointestinal bleeding (25.5% vs. 2.3%) and gastrointestinal reaction (48.9% vs. 31.4%) than the Ima cohort. The proportion of patients treated on schedule was significantly lower in the Das cohort than in the Ima cohort, and drug intolerance was the main reason for protocol violation. Conclusions: For patients with Ph+ ALL undergoing allo‐HSCT in CR1, imatinib prophylaxis achieved long‐term outcomes similar to those of dasatinib. The results of this study show patients with Philadelphia‐positive acute lymphoblastic leukemia undergoing allogeneic hematopoietic stem cell transplantation (HSCT) at first complete remission receiving imatinib or dasatinib prophylaxis had long‐term survival. The tolerance of imatinib after HSCT seemed better than dasatinib. [ABSTRACT FROM AUTHOR]

De novo anti‐HLA donor‐specific antibodies (DSAs) were rarely reported in stem cell transplantation patients. We present a case of 39‐year‐old acute myelogenous leukaemia patient who developed de novo DSAs only 16 days after transplantation with the highest mean fluorescence intensity (MFI) of 7406.23, which were associated with poor graft function (PGF). We used plasma exchange (PE) and intravenous immunoglobulin (IVIg) to reduce DSA level. A series of treatment including mesenchymal stem cells and donor cell transfusion were used to help recover graft function. On day 130, the patient achieved a successful engraftment. [ABSTRACT FROM AUTHOR]

Summary: Most events that limit life expectancy after allogeneic haematopoietic stem cell transplantation (allo‐HSCT) occur within the first 2 years; however, treatment outcomes in long‐term survivors who survive for at least 2 years post‐HSCT without relapse are yet to be elucidated. To explore the life expectancy trends and late complications and to assess the main mortality‐related factors, we investigated the characteristics of patients who received allo‐HSCT for haematological malignancies from 2007 to 2019 in our centre and survived in remission for 2 years. A cohort of 831 patients was enrolled; of these, 508 received grafts from haploidentical‐related donors (61.1%). The estimated overall survival rate at 10 years was 91.9% (95% confidence interval [CI], 89.8–93.5), which was affected by prior grade III–IV acute graft‐versus‐host disease (GVHD) (hazard ratio [HR], 2.98; 95% CI, 1.47–6.03; p = 0.002) and severe chronic GVHD (HR, 3.60; 95% CI, 1.93–6.71; p < 0.001). The probability of late relapse and non‐relapse mortality at 10 years was 8.7% (95% CI, 6.9–10.8) and 3.6% (95% CI, 2.5–5.1) respectively. The top cause of late mortality was relapsed (49.0%). Projected long‐term survival in 2‐year disease‐free survivors following allo‐HSCT was excellent. Strategies should be implemented to minimise the late death‐specific hazards in recipients. [ABSTRACT FROM AUTHOR]