A Meta-Analysis of Unrelated Donor Umbilical Cord Blood Transplantation versus Unrelated Donor Bone Marrow Transplantation in Acute Leukemia Patients

Abstract

Umbilical cord blood has emerged as an alternative stem cell source to bone marrow or peripheral blood stem cells. Umbilical cord blood transplantation (UCBT) is also potentially curative for acute leukemia. However, the effect of unrelated donor bone marrow transplantation (UBMT) and UCBT on the outcome of patients with acute leukemia has not been systematically reviewed. In the present meta-analysis, we systematically searched Cochrane Library, MEDLINE, EMBASE, and CNKI up to May 2011. Two reviewers extracted data independently. Seven studies totaling 3389 patients have been assessed. Pooled results found that the incidence of engraftment failure and transplantation-related mortality were higher in UCBT than in UBMT, and relative risks (RRs) were 4.27 (95% confidence interval [CI], 2.94-6.21) and 1.27 (95% CI, 1.01-1.59), respectively. The rates of acute and chronic graft-versus-host disease (GVHD) in the UCBT group were significantly lower than that in the UBMT group, and RRs were 0.71 (95% CI, 0.65-0.79) and 0.69 (95% CI, 0.52-0.91), respectively. The relapse rate was similar between the UCBT and UBMT group. The leukemia-free survival (LFS) and overall survival (OS) were significantly lower in the UCBT group than in the UBMT group; RRs were 1.14 (95% CI, 1.07-1.22) and hazard ratios (HRs) were 1.31 (95% CI, 1.16-1.48), respectively. Subgroup analysis showed that in patients with acute lymphoblastic leukemia (ALL), the survival was similar between UCBT and UBMT.

Comparison of Reduced-Intensity and Myeloablative Conditioning Regimens for Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Acute Myeloid Leukemia and Acute Lymphoblastic Leukemia: A Meta-Analysis

“…We decided to take year 2000 as the cut-off point for our subgroup analysis, as major transplant innovation and new technologies that allegedly improve the survival outcomes of HCT was introduced in year 2000 and thereafter. Moreover, published meta-analyses on HCT comparing Cord Blood and Unrelated donor transplant and RIC versus MAC-HCT in various hematological malignancies have included HCT performed in year 2000 and beyond [15,16].…”

“…No additional trials were identified from recent review articles [13,[15][16][17][18][19][20][21]. After screening, 1,278 articles were excluded on the basis of relevance, design, appropriate outcome data, and duplicate publications (Fig.…”

Rituximab-based treatments followed by adoptive cellular immunotherapy for biopsy-proven EBV-associated post-transplant lymphoproliferative disease in recipients of allogeneic hematopoietic stem cell transplantation

“…The incidence of primary malignancy relapse was lower than other population in our transplant centers and literatures. 36,37 A reasonable interpretation of our findings is that adoptive cells mediate graft-versus-tumor (GVT) response. It is recognized that DLI induce GVT effect.…”

Challenges faced in the treatment of acute lymphoblastic leukemia in adolescents and young adults

“…Furthermore, factors influencing outcomes following HSCT are complex and include the presence/absence of MRD prior to and immediately after transplant, the donor source, and the development of graft versus host disease both in terms of its harmful toxicity as well as its potentially beneficial graft versus leukemia effects. [73][74][75][76][77] Whether the influence of these factors is age-dependent remains to be seen. Similar to the aforementioned study from the Netherlands, there may not be a general benefit to HSCT in CR1 for all AYAs with ALL.…”