Objective: To compare the therapeutic 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 were HLA serologically matched. Total body irradiation plus cyclophosphamide was adopted in 56 cases and busulfan, Ara-C, cyclophosphamide conditioning regimen (modified BuCY) in 59 cases. T and B cell reconstitution at different time points was assayed with flow cytometer one year after transplantation. Graft versus host disease (GVHD) and early infection were observed after transplantation. The difference of haematopoietic and immunological reconstitution between the two groups were estimated with Independent-Samples T test. Kaplan-Meier survival analysis model was used to estimate the overall survival and the disease-free survival in the two groups.
Results: The time in WBC>1.0x10(9)/L was (13.1+/-2.4) d and (16.3+/-3.0) d (P=0.003), the time in PLT>20x10(9)/L was (14.9+/-6.6) d and (20.2+/-7.3) d (P=0.042), respectively, RD-BMT and URD-BMT. The time with WBC>1.0x10(9)/L was (12.5+/-2.9) d and (13.1+/-4.1) d (P=0.488), the time with PLT>20x10(9)/L was (12.2+/-4.2) d and (15.7+/-7.1) d (P=0.020), respectively, in RD-PBSCT and URD-PBSCT. The reconstitution of CD4+CD3+ at 1st, 3rd, 6th, 9th, 12th month, CD45RA+CD4+ at 1st month and CD8+CD3+ at 3rd month was different significantly between RD-HSCT and URD-HSCT. The incidence of II-IV acute GVHD, chronic GVHD and lethality of GVHD was 45.5% and 52.3%, 45.3% and 63.2%, 6.1% and 15.9%, respectively, in RD-HSCT and URD-HSCT groups. The relapse rate was 18.2% and 11.4%, respectively, in RD-HSCT and URD-HSCT groups. The incidence of early infection was 42.4% and 47.7% (P=0.696), respectively, in RD-HSCT and URD-HSCT groups. The overall survival and the disease-free survival rates at three-year follow-up were (67.8+/-6.9)% and (61.6+/-7.7)% (P=0.133), (62.3+/-6.9)% and (56.8+/-7.9)% (P=0.177), respectively, in RD-HSCT and URD-HSCT groups.
Conclusion: The therapeutic effect for leukemia is proximate in RD-HSCT and URD-HSCT.