الفهرس 
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Abstract
Introduction: Allogeneic hematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for acute leukemia . In the last decade, unmanipulated grafts without T cell depletion (TCD) have been used more frequently in the haplo-setting with the use of anti-thymocyte globulins (ATG) or post-transplant cyclophosphamide (PT-Cy) as GVHD prophylaxis with encouraging results. Aim of study: to assess the status of HLA-haploidentical HSCT as an alternative therapeutic approach to HLA -identical sibling transplantation for patients with acute leukemia. Methods: The study involved 242 Patients with a proven diagnosis of acute leukemia (both AML and ALL).This number was divided into two groups of patients including 89 patients who underwent Haploidentical bone marrow transplantation and 153 patients underwent HLA-identical sibling transplants. Results: The engraftment time was significantly prolonged in the haploidentical donor and PTCY groups Vs MSD and MTX groups (p =0.002, 0.02). On the other hand, it was comparable between PTCY groups in both donor types. There were comparable results between the studied groups and subgroups regarding the VOD, acute GvHD stage II-IV, and graft failure (p>0.05). In the haplo-HSCT , sepsis was a major complication Vs MSD and MTX groups (29.2% versus 15% and 13.3% ) (p <0.05). So the mortality rate was higher in the haplo-HSCT with more prevalent sepsis as a cause of death versus MSD group and in PTCY versus MTX group. CMV reactivation was higher in Haplo-HSCT vs MSD and MTX arms (31.5% versus 6.5% and 5.5% ). MSD and Haplo-HSCT who received PCTY showed comparable results with very low rates of extensive cGvHD (2.25%, 2.4%) . Besides low levels of cGVHD in haplo and PCTY vs MSD and MTX. Inside MSD group there were comparable results of acute GVHD with more significant rate of sepsis in the PTCY. Relapse was higher in MTX group Vs PTCY in MSD (p 0.004) . Among all patients, 1 yr OS was 77.7 % and 48.8 % at 4 years. Cumulative 4 years OS were 52 % and 43.8% in MSD and Haplo-HSCT. Leukemia free survival was comparable in MSD and Haplo-HSCT (p 0.573). By multivariate analysis, sepsis, graft failure, relapse and VOD were independent prognostic markers for worse OS (p <0.05). Graft failure, VOD, and sepsis were independent poor prognostic factors for (p <0.05). Summary/conclusion: Haplo-HSCT is evolving in acute leukemia with better post-HSCT outcomes drastic less cGvHD versus MTX based regimens while improvement in supportive care is still needed.