Comparison of outcomes in hematological malignancies treated with haploidentical or HLA-identical sibling hematopoietic stem cell transplantation following myeloablative conditioning: A meta-analysis

Abstract

PurposeHaploidentical and human leukocyte antigen (HLA)-identical sibling hematopoietic stem transplantation are two main ways used in allogeneic hematopoietic stem cell transplantation (allo-HSCT). In recent years, remarkable progress has been made in haploidentical allo-HSCT (HID-SCT), and some institutions found HID-SCT had similar outcomes as HLA-identical sibling allo-HSCT (ISD-SCT). To clarify if HID-SCT has equal effects to ISD-SCT in hematologic malignancies, we performed this meta-analysis.MethodsRelevant articles published prior to February 2017 were searched on PubMed. Two reviewers assessed the quality of the included studies and extracted data independently. Odds ratio (OR) and 95% confidence intervals (CIs) were calculated for statistical analysis.ResultsSeven studies including 1919 patients were included. The rate of platelet engraftment is significantly lower after HID-SCT versus ISD-SCT while there is no difference in neutrophil engraftment (OR = 2.58, 95% CI = 1.70–3.93, P < 0.00001). The risk of acute graft-versus-host disease (GVHD) is significantly higher after HID-SCT versus ISD-SCT (OR = 1.88, 95% CI = 1.42–2.49, P < 0.00001), but the relapse rate is lower in HID-SCT group (OR = 0.70, 95% CI = 0.55–0.90, P = 0.005). The incidence rates of overall survival (OS) and disease-free-survival/leukemia-free survival/relapse-free survival (DFS/LFS/RFS) after ISD-SCT are all significantly superior to HID-SCT (OR = 1.32, 95% CI = 1.08–1.62, P = 0.006; OR = 1.25, 95% CI = 1.03–1.52, P = 0.02). There is no significant difference in transplantation related mortality (TRM) rate after HID-SCT and ISD-SCT.ConclusionAfter myeloablative conditioning, patients receiving ISD-SCT have a faster engraftment, lower acute GVHD and longer life expectancy compared to HID-SCT with GVHD prophylaxis (cyclosporine A, methotrexate, mycophenolate mofetil and antithymoglobulin; CsA + MTX + MMF + ATG). Currently, HID-SCT with GVHD prophylaxis (CsA + MTX + MMF + ATG) may not replace ISD-SCT when HLA-identical sibling donor available.

Haploidentical versus matched donor stem cell transplantation for patients with hematological malignancies: a systemic review and meta-analysis

“…The results of our meta-analysis are not in complete agreement with those of Chen et al [55] who compared the outcomes of patients who received MA with either a haplo-SCT or a matched-SCT from a MRD. These authors suggest that matched-SCT should be preferred over haplo-SCT, because they found lower rates of platelet engraftment, higher risk of acute GVHD, and worse overall survival and disease-free survival among the haplo-SCT groups.…”

“…However, the haplo-SCT groups had a lower relapse rate and similar rates of neutrophil engraftment, chronic GVHD, and transplant-related mortality. The study by Chen et al [55] assessed 7 studies, 4 of which were included in our metaanalysis, that enrolled a total population of 1919 patients. We suspect that our larger population of over 11,000 patients allowed us to determine more accurate pooled effects for acute GVHD and relapse-related mortality.…”

A Case of Myeloproliferative Neoplasm with BCR-FGFR1 Rearrangement: Favorable Outcome after Haploidentical Allogeneic Transplantation

“…We performed a literature search and found an additional 11 cases with BCR-FGFR1 rearrangement treated with allogeneic HSCT (Table 1), and to our knowledge, this case is the first report of a patient with a BCR-FGFR1 MPN treated with haploidentical HSCT. Haploidentical donors allow patients who lack a HLA-matched one to receive a HCST with outcomes which are much like those obtained with matched donors [21]. HSCT may be the only therapeutic option for long-term survival at least until more efficacious TKIs become available.…”

Granulocyte Colony-Stimulating Factor-Primed Unmanipulated Haploidentical Blood and Marrow Transplantation

“…In summary, studies by others (36, 112, 113, 115) and us (109, 111) have suggested the inferiority of MSDT to haplo-SCT, indicating that, for AML patients with positive pre-MRD and HL, haploidentical donors might be selected first in experienced centers, although controversy remains. Therefore, a prospective, randomized study is needed to elucidate which one has better anti-leukemia activity, MSDT or haplo-SCT?…”

“…Here, we summarize the advances in inducing T cell tolerance by treating healthy donors with G-CSF. We discuss the recent advances in the Beijing Protocol mainly focusing on strategies that have been used for poor graft function (PGF) (26–30), virus infections (31–33), and relapse (34–36). We also indicate the application of G-CSF-primed allografts for other haploidentical allograft modalities.…”