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

• Published in: PloS one 2018-01, Vol.13 (1), p.e0191955-e0191955
• Main Authors: Chen, Dangui, Zhou, Di, Guo, Dan, Xu, Peipei, Chen, Bing
• Format: Article
• Language: English
• Subjects: Antigens; Biology and Life Sciences; Blood cancer; Blood diseases; Bone marrow; Care and treatment; Conditioning; Confidence intervals; Cyclosporins; Dosage and administration; Graft-versus-host reaction; Health risks; Hematologic diseases; Hematology; Hematopoietic stem cell transplantation; Hematopoietic stem cells; Histocompatibility antigen HLA; HLA antigens; Hospitals; Leukemia; Leukocytes; Life expectancy; Life span; Lymphoma; Medicine and Health Sciences; Meta-analysis; Methotrexate; Mortality; Mycophenolate mofetil; Mycophenolic acid; Patients; Physical Sciences; Prophylaxis; Quality assessment; Research and Analysis Methods; Statistical analysis; Stem cell transplantation; Stem cells; Studies; Survival; Transplantation; Transplants & implants
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0191955

Haploidentical 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. Relevant 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. Seven 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. After 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.