Comparative Efficacy and Clinical Outcomes of Haploidentical Stem Cell Transplantation to Other Stem Sources for Treatment in Acute Myeloid Leukemia and Myelodysplastic Syndrome Patients: A Systematic Review and Meta-Analysis

Abstract

The use of allogeneic hematopoietic stem cell transplantation (HSCT) is recommended during the first complete remission of acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS). However, only 30% of these cases have fully matched sibling donors (MSDs). Alternatively, matched unrelated donors (MUDs) and haploidentical (haplo) donors from first-degree relatives increase the access to transplantation, with some reported differences in outcomes. The current systematic review and meta-analysis was conducted with the aim of summarizing the results of those studies to compare the efficacy and toxicity of MSD-HSCT and MUD-HSCT versus haplo-HSCT for patients with AML or MDS. Articles published before September 15, 2018, were individually searched for in two databases (MEDLINE and EMBASE) by two investigators. The effect estimates and 95% confidence intervals (CIs) from each eligible study were combined using the Mantel–Haenszel method. A total of 14 studies met the eligibility criteria and were included in the meta-analysis. The overall survival rates were not significantly different between the groups, with pooled odds ratios of the chance of surviving at the end of the study when comparing haplo-HSCT to MSD-HSCT and comparing haplo-HSCT to MUD-HSCT of 0.85 (95% CI: 0.70 to 1.04; I 2 = 0%) and 1.12 (95% CI: 0.89 to 1.41; I 2 = 33%), respectively. The pooled analyses of other outcomes also showed comparable results, except for the higher grade 2 to 4 acute graft-versus-host disease (GvHD) for patients who received haplo-HSCT than those who received MSD-HSCT, and the better GvHD-free, relapse-free survival and the lower chronic GvHD than the patients in the MUD-HSCT group. These observations suggest that haplo-HSCT is a reasonable alternative with comparable efficacy if MSD-HSCT and MUD-HSCT cannot be performed. Nonetheless, the primary studies included in this meta-analysis were observational in nature, and randomized-controlled trials are still needed to confirm the efficacy of haplo-HSCT.

Hematopoietic stem cell transplantation in acute myeloid leukemia from haploidentical donors compared with HLA-matched related donors

“…According to our data, haplo-HSCT is associated with tendency for higher frequency of acute GVHD stage 2-4, thus being in agreement with other studies [8,9]. Meanwhile, frequency of severe acute GVHD (stage 3-4) in these patients did not differ from MRD-HSCT.…”

“…Relapse was determined as bone marrow recurrence of disease or extramedullary lesions. The date of hematopoietic recovery was referred as the first of three subsequent days with absolute neutrophil number of >0.5×10 9 /L, and thrombocyte recovery was referred as the first of seven subsequent days platelet numbers >50×10 9 /L, without blood transfusion requirements.…”

Clinical Significance of Haplo-Fever and Cytokine Profiling After Graft Infusion in Allogeneic Stem Cell Transplantation From Haplo-Identical Donors

“…Allogeneic stem cell transplantation (allo-HSCT) is a potentially curative treatment for various hematological malignancies. Allo-HSCT from haplo-identical donors (haplo-HSCT) is well established as an alternative option in patients without HLA-matched related or unrelated donors ( 1 – 4 ). Graft versus host disease (GvHD) prophylaxis by post-transplantation cyclophosphamide (PTCy) is the mainstay in haplo-HSCT ( 5 , 6 ).…”

Transplante de células-tronco hematopoiéticas: iniquidades na distribuição em território brasileiro, 2001 a 2020

“…Uma explicação para esses valores pode ser a falta de experiência das equipes de TCTH brasileiras em trabalhar com essa técnica. Ademais, na última década ocorreram avanços expressivos no tratamento por meio da utilização de doadores haploidênticos (quando a compatibilidade é parcial), os quais apresentaram altas taxas de sucesso 23,24 . Dessa forma, é provável que equipes que transplantavam pela técnica do cordão umbilical passaram a recorrer mais a essa nova técnica.…”