Allogeneic Bone Marrow Transplantation versus Peripheral Blood Stem Cell Transplantation for Hematologic Malignancies in Children: A Systematic Review and Meta-Analysis

Abstract

Peripheral blood stem cell transplantation (PBSCT) is being increasingly performed as an alternative to bone marrow transplantation (BMT); however, PBSCT has not been proven to have equivalent outcome to BMT. We conducted a meta-analysis to compare survival rates and treatment-related complications between PBSCT and BMT for pediatric hematologic malignancies. We searched Medline, Embase plus Embase classics, and the Cochrane Central Register of Controlled Trials for the terms "hematopoietic stem cell transplantation" AND "allogeneic transplantation" AND "children", including randomized controlled studies and cohort studies without language limitations. We identified 7 of 5368 studies for inclusion in our meta-analysis. The cohorts of these studies included a total of 4328 patients, 3185 who underwent BMT and 1143 who underwent PBSCT. Five-year overall survival was similar in the 2 groups (PBSCT, 56.2%; BMT, 63.5%; relative risk [RR], 1.17; 95% confidence interval [CI], .91 to 1.52), as was the 5-year event-free survival (PBSCT, 49.9%; BMT, 57.2%; RR, 1.14; 95% CI, .93 to 1.39). The incidences of nonrelapse mortality and chronic graft-versus-host disease were higher in the PBSCT group compared with the BMT group (RR, 1.73; 95% CI, 1.50 to 1.99 versus RR, 1.55; 95% CI, 1.18 to 2.03). This meta-analysis found insufficient evidence to conclude that peripheral blood stem cells are equivalent to bone marrow. The results indicate that bone marrow can still be a preferred donor source for pediatric hematologic malignancies.

Risk factors and outcomes in children with high-risk B-cell precursor and T-cell relapsed acute lymphoblastic leukaemia: combined analysis of ALLR3 and ALL-REZ BFM 2002 clinical trials

“…The results of this paper confirm previous observations of poor outcomes in older patients [24], relapses within 18 months of diagnosis, with isolated medullary relapse [2] and with HR cytogenetics [22]. Neither the donor nor the stem cell source influenced outcomes [25].…”

Allogeneic hematopoietic stem cell transplant in pediatric acute myeloid leukemia: Lessons learnt from a tertiary care center in India

“…Our study suggests that in resource‐limited countries performing HSCT in active disease is futile and that targeted therapy if feasible may be used to achieve CR before subjecting the patient to HSCT. Though our study found a significant difference in outcome of patients depending on the stem cell source, this finding needs caution in its interpretation since there were only 5 patients who received a bone marrow graft and a large recent meta‐analysis including data from 5368 patients found no difference between the two stem cell sources 41 …”

“…Though our study found a significant difference in outcome of patients depending on the stem cell source, this finding needs caution in its interpretation since there were only 5 patients who received a bone marrow graft and a large recent meta-analysis including data from 5368 patients found no difference between the two stem cell sources. 41 Multiple parameters have been evaluated to identify patients having a high likelihood of AML relapse after allo-HSCT. Presence of MRD using multiparameter flow cytometry or real-time quantitative polymerase chain reaction or fluorescence in situ hybridization before transplant is associated with a high risk of relapse and inferior outcomes.. [42][43][44] Given its strong independent predictive value, MRD assessment is recommended at various time points in treatment of AML patients, including that before proceeding to transplant.…”

DNA methylation of hematopoietic stem/progenitor cells from donor peripheral blood to patient bone marrow: implications for allogeneic hematopoietic stem cell transplantation

“…However, in the last years, mPB-HSCT significantly increased, accounting for 70% of adult and 30% of children transplants [7], probably due to an easy sourcing of HSPCs, a rapid engraftment of cells and their possible use in non-ablative regimens [4,8]. Despite the great progress made in recent years including refinement of donor selection, adverse reactions, such as graft-versus-host disease (GvHD), infections and relapse of the underlying disease, still represent a major cause of mortality in transplanted patients [5].…”