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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2019, Vol. 13 Issue (1) : 45-56    https://doi.org/10.1007/s11684-017-0595-7
REVIEW
Everyone has a donor: contribution of the Chinese experience to global practice of haploidentical hematopoietic stem cell transplantation
Meng Lv1, Yingjun Chang1, Xiaojun Huang1,2()
1. Peking University People’s Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
2. Peking-Tsinghua Center for Life Sciences, Beijing 100044, China
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Abstract

Human leukocyte antigen (HLA)-matched donors for hematopoietic stem cell transplantation (HSCT) have long been scarce in China. Haploidentical (haplo) donors are available for the vast majority of patients, but toxicity has limited this approach. Three new approaches for haplo-HSCT originated from Italy, China, and USA in 1990 and have been developed to world-renowned system up to now. The Chinese approach have been greatly improved by implementing new individualized conditioning regimens, donor selection based on non-HLA systems, risk-directed strategies for graft-versus-host disease and relapse, and infection management. Haplo-HSCT has exhibited similar efficacy to HLA-matched HSCT and has gradually become the predominant donor source and the first alternative donor choice for allo-HSCT in China. Registry-based analyses and multicenter studies adhering to international standards facilitated the transformation of the unique Chinese experience into an inspiration for the refinement of global practice. This review will focus on how the new era in which “everyone has a donor” will become a reality in China.

Keywords haploidentical hematopoietic stem cell transplantation      conditioning      graft-versus-host disease      relapse      infection      donor selection     
Corresponding Authors: Xiaojun Huang   
Just Accepted Date: 20 December 2017   Online First Date: 18 April 2018    Issue Date: 12 March 2019
 Cite this article:   
Meng Lv,Yingjun Chang,Xiaojun Huang. Everyone has a donor: contribution of the Chinese experience to global practice of haploidentical hematopoietic stem cell transplantation[J]. Front. Med., 2019, 13(1): 45-56.
 URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-017-0595-7
http://academic.hep.com.cn/fmd/EN/Y2019/V13/I1/45
Center
Nation
Patients
n
Conditioning Donor
Grafts
aGvHD
II–IV/III and IV
cGvHD
Total/Ex
Relapse TRM OS/DFS Publication/
References
Wuhan Union
China
110 Bu+ Cy+ IDA
ATG (T 6 mg) + CD25
G-PB±
G-BM
II–IV 28.6%
III and IV 14.3%
33.2%
Ex 13.8%
23.4% 18.8% Three-year OS 62.9%
DFS 59.1
Bone Marrow Transplant 2017 [41]
PLA General
China
130 Bu+ Cy or TBI
ATG (T 10 mg)
G-PB II–IV 26.9%
III and IV 14.9%
38.6%
Ex 16.5%
26.9% 24.1% Three-year OS 45.6%
DFS 44.2%
Bone Marrow Transplant 2016 [53]
Zhujiang
China
105 Bu+ Cy+ Flu
ATG (T 12.5 mg)
G-PB II–IV 21.9%
III and IV 14.3%
24.1%
Ex 3.8%
21.0% 34.9% Three-year OS 52.6%
DFS 43.1%
Bone Marrow Transplant 2016 [54]
Fujian Union
China
63 Bu+ Cy+ Flu
ATG (T 10 mg/F 40 mg)
G-BM+
G-PB
II–IV 11.0%
III and IV 6.3%
9.5% 11.9% 20.6% Two-year OS 61.3%
DFS 58.3%
Oncotarget 2016 [55]
Milan/Berlin
Italy/Germany
121 Treosulfan+ Flu
ATG (F 10 mg)
G-PB II–IV 35%
III and IV 22%
35.5
Ex 24.8%
36% 31% Three-year OS 25%
DFS 20%
Leukemia 2015 [52]
Catholic
South Korea
80 Bu+ TBI+ Flu
ATG (T 6 mg)
G-PB II–IV 47.5%
III and IV 11.2%
45.0%
Ex 26.3%
18.8% 12.5% Two-year OS 66.0%
DFS 61.1%
Biol Blood Marrow Transplant 2015 [51]
Tokyo, Japan 34 Bu+ Flu
ATG (F 8 mg)
G-PB II–IV 30.7% Ex 20% 41.2% 26.5% One-year OS 47.1% Biol Blood Marrow Transplant 2015 [50]
Peking
China
1210 Bu+ Cy
ATG (T 10 mg)
G-BM+
G-PB
II–IV 40%
III and IV 12%
50%
Ex 21%
17.0% 17.0% Three-year OS 70%
DFS 67%
Blood 2014 [66]
Zhejiang
China
99 Bu+ Cy
ATG (F 10 mg)
G-PB II–IV 42.4%
III and IV 17.2%
41.4% 14.2% 23.2% Five-year OS 60.8%
DFS 58.3%
Blood 2014 [36]
Xinqiao, etc. Seven centers
China
178 Bu+ Cy+ ATG G-BM+
G-PB
II–IV 42.4% III and IV 10.2% 52.8% 38.2% 6.7% Two-year OS 59.6%
DFS 55.1%
Biol Blood Marrow Transplant 2014 [49]
Soochow
China
50 Bu+ Cy or TBI
ATG (T 10 mg)
G-BM±G-PB+
Cord
II–IV 20%
III and IV 10%
19.3% 19.8% 16.2% One-year OS 78.6%
DFS 64.0%
Bone Marrow Transplant 2014 [48]
Pescara/Hashomer, Italy/Israel 80 Bu+ Flu
ATG (F 20 mg) + CD25
G-BM II–IV 24%
III and IV 5%
12%
Ex 5%
28% 36% Three-year OS 45%
DFS 38%
Blood 2013 [47]
Asan, etc.
South Korea
83 Bu+ Flu
ATG (T 12 mg)
G-PB II–IV 20% 34%
Ex 18%
32.5% 18% Two-year OS 56%
DFS 45%
Blood 2011 [46]
Tab.1  G-CSF+ ATG-based haplo-HSCT for leukemia
Fig.1  Annual allo-HSCT cases of the Chinese Registry and percentage of different donor sources in 2008–2016. Haplo, haploidentical donors; ISD, HLA identical sibling donor; URD, unrelated donor; cord: cord blood.
Beijing Protocol Post-transplant cyclophosphamide T cell depletion
Numbers of patients 1210 681 161
Graft failure 1% 9%–12% 3.7%
II–IV aGvHD 40% 25%–42% 12%
cGvHD 50% 20%–41% 3.7%
Relapse 17% 28%–45% 23%
TRM 17% 16%–17% 38.5%
DFS Three-year 67% Two-year 41%–54% Four-year 38.5%
Reference Blood 2014 [66] J Clin Oncol 2017 [94] Blood 2015 [95]
Tab.2  Comparison of the largest cohort from different haplo-HSCT approaches for leukemia
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