A Study Comparing Haploidentical Hematopoietic Stem Cell Transplantations (HSCTs) From Young Non-first-degree and Older First-degree Donors in Hematological Malignancies

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• Patient Inclusion Criteria:
• Patient age 13-78 years
• Absence of a suitable HLA identical related or unrelated hematopoietic stem cell donor
• Absence of a suitable partially HLA-mismatched (haploidentical), first-degree related donor aged between 18 and 50
• Presence of both HLA haploidentical young non-first-degree (age ≤ 40) and older first-degree (age \>50) donors
  • Eligible diagnoses:
  • AML（excluding APL） with at least one of the following:
• median- or high- risk according to the WHO prognostic stratification system
• failure to achieve CR after 2 cycles of induction chemotherapy
• AML arising from MDS or a myeloproliferative disorder, or secondary AML
• patients in CR2 or beyond
  • Mixed-phenotype acute leukemia (MPAL) in morphological remission Acute lymphoblastic leukemia (T or B) in morphological remission
  • MDS with at least one of the following:
• IPSS score of INT-2 or greater
• IPSS score of INT-1 with life-threatening cytopenias, including those generally requiring greater than weekly transfusions
  • A first allo-HCT
  • Adequate end-organ function
  • ECOG performance status \< 2
  • No other contraindications for HSCT
  • Signature of the informed consent
  • Patient Exclusion Criteria
• Availability of suitable HLA identical related or unrelated hematopoietic stem cell donors
• Availability of suitable partially HLA-mismatched (haploidentical), first-degree related donor aged between 18 and 50
• Not the first allo-HCT
• Presence of uncontrolled bacterial, viral, or fungal infection
• Patients with severe heart, lung, liver and kidney insufficiency
• HIV-positive patients
• Women of childbearing potential who are pregnant (β-HCG+) or breast feeding
• Patients with a psychiatric history
• ECOG performance status ≥ 2
• Patients with malignancies other than the primary disease
• Refusal to sign the informed consent
  • Donor Inclusion Criteria:
• The donor and recipient must be HLA haploidentical
• Meets institutional selection criteria and medically fit to donate
• Lack of recipient anti-donor HLA antibody
  • Donor Exclusion Criteria:
• The donor and recipient are HLA identical
• Has not donated blood products to recipient