Shen Yifan, Lu Haiyang, Lin Jieping, Liu Minyuan, Chu Mengqian, Shen Danya, Zhang Xiang, Fan Yi, Chen Jia, Hu Shaoyan, Wu Depei, Zhou Biqi, Hu Xiaoxia, Zhou Hongsheng, Xu Yang
Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, P. R. China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, P. R. China.
Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China.
Transplant Cell Ther. 2025 Aug 18. doi: 10.1016/j.jtct.2025.08.009.
Allogeneic hematopoietic cell transplantation (allo-HCT) is a promising treatment option for T-cell acute lymphoblastic leukemia (T-ALL). Co-infusion of umbilical cord blood (UCB) in haploidentical cell transplantation (haplo HCT) (haplo-cord HCT) for acute myeloid leukemia and B-cell acute lymphoblastic leukemia is a promising treatment in previous studies, but the clinical outcomes of T-ALL patients with haplo HCT whether combined with UCB remain unclear. Between 2012 and 2022, a total of 281 T-ALL patients including 190 with UCB (haplo-cord HCT group) and 91 without UCB (haplo HCT group) in 4 centers were retrospectively analyzed. No differences were observed in neutrophil or platelet reconstitution or transplantation-related complications including cumulative incidence of grade II-IV aGVHD. In the haplo-cord HCT group, there was a greater absolute count of CD3-CD16+CD56+ cells at +1 month (P = .003) and +3 months (P < .001) and a greater absolute count of CD3+ cells at +9 months (P = .025) and +1 year (P = .004); and the incidence of Epstein-Barr virus (EBV) viremia was lower in the haplo-cord HCT group (P < .002). Compared with the haplo HCT group, the haplo-cord HCT group exhibited better 2-year prognosis (OS: 72.7% versus 61.0%, P = .008; DFS: 67.0% versus 49.6%, P = .001; CIR: 23.9% versus 36.8%, P = .048) and similar NRM (12.0% versus 21.3%, P = .061). Subgroup analyses suggested that patients who were adolescents/young adults (P = .016), exhibited a non-early T-cell precursor (P = .001), required ≥2 courses of induction chemotherapy to achieve complete remission (CR) (P < .001) and were at CR1 status at transplantation (P = .005) could benefit from haplo-cord HCT for survival. Multivariate analyses revealed that haplo-cord HCT independently improved the OS (P = .004) and DFS (P < .001) of T-ALL patients. In conclusion, haplo-cord HCT may represent an optimal treatment strategy for T-ALL patients.
