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Mismatched unrelated donors allogeneic hematopoietic stem cell transplantation with antithymocyte globulin for hematological malignancies: a multicenter retrospective study in China

Bone Marrow Transplantation volume 60, pages 201–210 (2025)Cite this article

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Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) utilizing mismatched unrelated donors (MMUD) present a vital option for patients with hematologic malignancies without human leukocyte antigen (HLA)-matched donors. This multicenter retrospective study encompassed 211 adults with hematological malignancies receiving allo-HSCT with antithymocyte globulin (ATG) from ≥1 HLA locus MMUD. The findings revealed cumulative incidences of II-IV acute graft-versus-host disease (GVHD) at 180 days at 26.5%, and III-IV acute GVHD at 12.3%, with 3-year cumulative incidences for total and moderate-severe chronic GVHD at 37.0% and 21.0%. The 3-year non-relapse mortality (NRM) and relapse rates were 19.7% and 25.8%. The study reported a 3-year overall survival (OS) rate of 63.1%, a disease-free survival (DFS) rate of 54.5%, and a GVHD-free, relapse-free survival (GRFS) rate of 40.8%. Administration of a lower-dose ATG-Genzyme (ATG-G, ≤ 6 mg/kg) correlated with improved engraftment without significantly affecting survival, relapse, or viral reactivation rates. The quantity of HLA mismatches did not impact engraftment, GVHD, viral reactivation, OS, DFS, GRFS, relapse, or NRM. In conclusion, MMUD allo-HSCT with ATG demonstrates favorable outcomes for patients with hematological malignancies, with no evident correlation between the degree of mismatch and post-transplantation results. Utilizing a lower dose of ATG-G ( ≤ 6 mg/kg) proved efficacious, delivering comparable clinical advantage.

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Fig. 1: Engraftment.
Fig. 2: Complications after transplantation.
Fig. 3: Survival curve.

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Data available on request from the authors.

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Acknowledgements

This research was supported by grants from the National Natural Science Foundation of China (Grant No. 82170205, 82300240).

Funding

This research was supported by grants from the National Natural Science Foundation of China (Grant No. 82170205, 82300240).

Author information

Author notes

  1. These authors contributed equally: Lin Li, Yi Chen, Ting Chen, Yajing Xu.

  2. These authors jointly supervised this work: He Huang, Erlie Jiang, Xi Zhang, Yi Luo.

Authors and Affiliations

  1. Bone Marrow Transplantation Center of The First Affiliated Hospital & Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, Zhejiang, CN, China

    Lin Li, Panpan Zhu, Jimin Shi, Yanmin Zhao, Xiaoyu Lai, Jian Yu, Lizhen Liu, He Huang & Yi Luo

  2. Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, CN, China

    Lin Li, Panpan Zhu, Jimin Shi, Yanmin Zhao, Xiaoyu Lai, Jian Yu, Lizhen Liu, He Huang & Yi Luo

  3. Zhejiang Province Engineering Research Center for Stem Cell and Immunity Therapy, Hangzhou, Zhejiang, CN, China

    Lin Li, Panpan Zhu, Jimin Shi, Yanmin Zhao, Xiaoyu Lai, Jian Yu, Lizhen Liu, He Huang & Yi Luo

  4. Department of Hematology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, CN, China

    Yi Chen, Kaiqian Yang & Songfu Jiang

  5. Medical Center of Hematology, Xinqiao Hospital, Chongqing, CN, China

    Ting Chen, Yimei Feng & Xi Zhang

  6. Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan, CN, China

    Yajing Xu

  7. National Clinical Research Center for Geriatric Diseases (Xiangya Hospital), Changsha, Hunan, CN, China

    Yajing Xu

  8. Hunan Hematology Oncology Clinical Medical Research Center, Changsha, Hunan, CN, China

    Yajing Xu

  9. State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, CN, China

    Weihua Zhai, Xiaofei Ni & Erlie Jiang

  10. Tianjin Institutes of Health Science, Tianjin, CN, China

    Weihua Zhai, Xiaofei Ni & Erlie Jiang

  11. Department of Hematology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, CN, China

    Yang Xu & Xi Qiu

  12. Zhejiang Provincial People’s Hospital, Hematology and Hematopoietic Stem Cell Transplant Center, Hangzhou, Zhejiang, CN, China

    Xiaolu Song & Jianping Lan

  13. Department of Hematology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, CN, China

    Ting Yang

  14. Department of Hematology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, CN, China

    Ting Yang

  15. Institute of Precision Medicine, Fujian Medical University, Fuzhou, Fujian, CN, China

    Ting Yang

  16. The Affiliated People’s Hospital of Ningbo University, Ningbo, Zhejiang, CN, China

    Ying Lu

  17. Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, CN, China

    Yicheng Zhang

  18. Key Laboratory of Organ Transplantation, Ministry of Education, NHC Key Laboratory of Organ Transplantation, Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, Hubei, CN, China

    Yicheng Zhang

  19. Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, Hubei, CN, China

    Yicheng Zhang

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Contributions

All authors contributed to the study conception and design. Data collection and analysis were performed by Lin Li, Yi Chen, Ting Chen and Yajing Xu. The first draft was written by Lin Li and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to He Huang, Erlie Jiang, Xi Zhang or Yi Luo.

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Competing interests

The authors declare no competing interests.

Ethics approval & consent to participate

All methods were performed in accordance with the relevant guidelines and regulations. Ethical approval was obtained from the Clinical Research Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine (No. IIT20230944A). Informed consent was obtained from all participants prior to their involvement in the study.

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Li, L., Chen, Y., Chen, T. et al. Mismatched unrelated donors allogeneic hematopoietic stem cell transplantation with antithymocyte globulin for hematological malignancies: a multicenter retrospective study in China. Bone Marrow Transplant 60, 201–210 (2025). https://doi.org/10.1038/s41409-024-02454-5

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