Comparison of Allogeneic Stem Cell Transplant and Autologous Stem Cell Transplant in Refractory or Relapsed Peripheral T-Cell Lymphoma

Abstract

IMPORTANCE Hematopoietic stem cell transplant (HSCT) is an advisable option for refractory or relapsed peripheral T-cell lymphoma (R/R-PTCL), but whether allogeneic HSCT or autologous HSCT is more beneficial is unknown.OBJECTIVE To compare the effectiveness and safety of allogeneic HSCT vs autologous HSCT in patients with R/R-PTCL. DATA SOURCESA systematic search of the PubMed, Embase, the Cochrane Central Register of Controlled Trials, Wanfang, and China National Knowledge Infrastructure databases with the search items refractory or relapsed peripheral T-cell lymphoma, ASCT/autologous stem-cell transplantation, allo-HSCT/allogeneic stem-cell transplantation, therapeutic effect, and treatment was conducted for articles published from January 12, 2001, to October 1, 2020. STUDY SELECTION After duplicate and irrelevant publications were discarded, 329 were ineligible according to the inclusion (clinical trials or retrospective studies with >10 samples) and exclusion criteria (articles without overall survival [OS], progression-free survival [PFS], and transplantationrelated mortality [TRM]). Thirty trials were included in the meta-analysis. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.DATA EXTRACTION AND SYNTHESIS Data on study design, individual characteristics, and outcomes were extracted. All statistics were pooled by applying a random-effects model. MAIN OUTCOMES AND MEASURESThe prespecified main outcomes were OS, PFS, and TRM. RESULTSOf 6548 articles, data extracted from the 30 studies (including 880 patients who underwent allogeneic HSCT and 885 who underwent autologous HSCT) were included in this metaanalysis. In the allogeneic HSCT group, a 3-year OS of 50% (95% CI, 41%-60%) and PFS of 42% (95% CI, 35%-51%), a 5-year OS of 54% (95% CI, 47%-62%) and PFS of 48% (95% CI, 40%-56%), and a 3-year TRM of 32% (95% CI, 27%-37%) were observed. In the autologous HSCT group, a 3-year OS of 55% (95% CI, 48%-64%) and PFS of 41% (95% CI, 33%-51%), a 5-year OS of 53% (95% CI, 44%-64%) and PFS of 40% (95% CI, 24%-58%), and a 3-year TRM of 7% (95% CI, 2%-23%) were observed. CONCLUSIONS AND RELEVANCEIn this systematic review and meta-analysis, OS and PFS were similar in the allogeneic HSCT and autologous HSCT groups; however, allogeneic HSCT was associated with specific survival benefits among patients with R/R-PTCL.

Perspectives on Challenges to Cell Therapy Development in Taiwan: Strengthening Evidential Standards and Ways Forward

“…Yet, it is evident that physicians and industry experts were dissatisfied with their efficacy outcomes. This is in line with the literature considering efficacy is patient specific and largely influenced by a number of factors ( McAllister et al, 2012 ; Hurley et al, 2018 ; Krause et al, 2019 ; Du et al, 2021 ). Furthermore, this dissatisfaction may be predictable considering that those approved cells were intended for life-threatening diseases such as end stage cancer.…”

Comparison of international guidelines for early-phase clinical trials of cellular and gene therapy products

“…On the other hand, all of the studies used multiple administrations and conducted safety evaluations up to 28 days after the last administration. This seems to be because there was a basis for the empirical use of autologous NK cells and it was considered relatively safe [ 30 ]. It is presumed that the differences in dose and regimen between each study stemmed from the differences in the conditions of the donor and non-clinical data that were the basis for their setting.…”

Efficacy of chimeric antigen receptor T cell therapy and autologous stem cell transplant in relapsed or refractory diffuse large B-cell lymphoma: A systematic review

“…As both randomized clinical trials (RCT) and nonrandomized clinical trials were involved, we adopted the Methodological Index for Non-randomized Studies (MINORS) to assess the quality of the included studies. Each item was scored as 0 (not reported), 1 (reported but inadequate), or 2 (reported and adequate) ( 27 ). We conducted the Begg’s and Egger’s tests to evaluate publication bias.…”