造血细胞移植（HCT）可提高急性白血病的生存率。在发展中国家，门诊同种异体 HCT 可降低成本并提高移植率。我们报告了急性白血病门诊患者 HLA 一致和半相合 HCT 的结果。 这项单中心回顾性队列研究分析了 121 名患有急性髓母细胞 (AML) 和急性淋巴细胞白血病 (ALL) 的成人患者，这些患者在减少外周血同种异体移植后接受门诊同种异体 HCT - 2012-2022 年的强度调节 (RIC)。有 81 例 (67%) 单倍体移植和 40 例 (33%) HLA 相同移植。与半相合 HCT 相比，第 100 天时 HLA 相合的完全嵌合 (CC) 没有差异（32.5% 和 38.2%，P=0.054）。 HCT后并发症，包括中性粒细胞减少性发热（59.3% vs. 40%）、急性移植物抗宿主病（aGVHD）（46.9% vs. 25%）、细胞因子释放综合征（CRS）（18.5% vs. 2.5%） ）和住院（71.6% vs 42.5%）在半相合 HCT 中显着更高。 HLA 一致和单倍体 HCT 的两年总生存率 (OS) 分别为 60.6% 和 46.9% (P=0.464)。不同移植类型的 2 年无病生存率 (DFS) 没有差异（33.3% vs. 35%，P=0.924）。在多变量分析中，30 天（HR 8.8，P=0.018）和 100 天（HR 28.5，P=0.022）时的阳性可测量残留病灶 (MRD) 与较低的 OS 相关，但与非复发死亡率 (NRM) 无关。 P=0.252 和 P=0.123，单变量）。在单变量分析中，30 天和 100 天 MRD 均与较低的 DFS 率相关（P=0.026 和 P=0.006），但在多变量分析中只有第 30 天 MRD 显着（P=0.050）。在复发的情况下，在单变量和多变量分析中，只有第 100 天的 MRD 与风险增加相关（HR 4.48，P=0.003 和 HR 4.67，P=0.008）。慢性移植物抗宿主病（cGVHD）对NRM具有保护作用（HR 0.38，P=0.015）。移植类型之间的累积复发率（CIR）没有差异（P=0.126）。 44 例（36.4%）患者死亡，HCT 类型之间无差异（P=0.307）。脓毒性休克是最常见的死亡原因，有 17 例，不同移植类型之间没有差异。RIC 后门诊外周血同种异体 HCT 对于低收入人群中患有急性髓细胞或淋巴细胞白血病的成年患者来说是一种有效且有效的替代方案。版权所有 © 2024 海梅-佩雷斯、巴尔德斯皮诺-瓦尔德斯、戈麦斯-德莱昂、巴拉甘-朗戈里亚、多明格斯-维拉纽瓦、坎图-罗德里格斯、古铁雷斯-阿吉雷和戈麦斯-阿尔马格尔。

Hematopoietic cell transplantation (HCT) increases survival for acute leukemia. Outpatient allogeneic HCT reduces costs and increases transplant rates in developing countries. We report outcomes of outpatient HLA-identical and haploidentical HCT in acute leukemia.This single-center retrospective cohort study analyzed 121 adult patients with acute myeloblastic (AML) and acute lymphoblastic leukemia (ALL) receiving an outpatient allogeneic HCT with peripheral blood allografts after reduced-intensity conditioning (RIC) from 2012-2022.There were 81 (67%) haploidentical and 40 (33%) HLA-identical transplants. Complete chimerism (CC) at day +100 was not different in HLA-identical compared to haploidentical HCT (32.5% and 38.2%, P=0.054). Post-HCT complications, including neutropenic fever (59.3% vs. 40%), acute graft-versus-host-disease (aGVHD) (46.9% vs. 25%), cytokine release syndrome (CRS) (18.5% vs. 2.5%), and hospitalization (71.6% vs 42.5%) were significantly more frequent in haploidentical HCT. Two-year overall survival (OS) was 60.6% vs. 46.9%, (P=0.464) for HLA-identical and haplo-HCT, respectively. There was no difference in the 2-year disease-free-survival (DFS) (33.3% vs. 35%, P=0.924) between transplant types. In multivariate analysis, positive measurable residual disease (MRD) at 30 days (HR 8.8, P=0.018) and 100 days (HR 28.5, P=0.022) was associated with lower OS, but not with non-relapse mortality (NRM) (P=0.252 and P=0.123, univariate). In univariate analysis, both 30-day and 100-day MRD were associated with lower DFS rates (P=0.026 and P=0.006), but only day 30 MRD was significant in multivariate analysis (P=0.050). In the case of relapse, only MRD at day 100 was associated with increased risk in the univariate and multivariate analyses (HR 4.48, P=0.003 and HR 4.67, P=0.008). Chronic graft-versus-host-disease (cGVHD) was protective for NRM (HR 0.38, P=0.015). There was no difference in cumulative incidence of relapse (CIR) between transplant types (P=0.126). Forty-four (36.4%) patients died, with no difference between HCT type (P=0.307). Septic shock was the most frequent cause of death with 17 cases, with no difference between transplant types.Outpatient peripheral blood allogenic HCT after RIC is a valid and effective alternative for adult patients suffering acute myeloblastic or lymphoblastic leukemia in low-income populations.Copyright © 2024 Jaime-Pérez, Valdespino-Valdes, Gómez-De León, Barragán-Longoria, Dominguez-Villanueva, Cantú-Rodríguez, Gutiérrez-Aguirre and Gómez-Almaguer.