Nonmyeloablative, HLA-Mismatched Unrelated Peripheral Blood Transplantation with High-Dose Post-Transplantation Cyclophosphamide

Outcomes with mismatched unrelated donor allogeneic hematopoietic stem cell transplantation in adults: A systematic review and meta-analysis

“…A total of 3336 patients from 19 studies were included in this systematic review and meta-analysis, with a median age of 52.1 (6-76.5) years ( 16 , 19 – 36 ), and 53% (n=1659/3116) of recipients were male ( 20 – 25 , 27 – 36 ). Eighty-six percent (n=1055/1222) patients were Caucasian and 5.8% (n=71/1222) were African American ( 30 – 16 ). The primary graft source was bone marrow (BM) in 19% (n=646/3336) and peripheral blood stem cells (PBSC) in 81% (n=2690/3336) of the recipients ( 16 , 19 – 36 ).…”

“…Reduced-intensity conditioning (RIC) conditioning was used for 65.6% (n=2191) of the patients while 32% (n=1066) of patients received myeloablative conditioning (MAC). In-vivo TCD was performed in 56.7% of the patients, as reported by ten studies with available data (n=1359/2395) ( 20 – 26 , 28 , 30 , 31 ). Among them, 20% (n=272) patients received anti-thymocyte globulin (ATG) and 9.2% (n=125) patients received alemtuzumab whereas details regarding in-vivo TCD regimen were not available in 70.8% (n=962) of patients from studies based on registry databases.…”

“…HLA mismatch (MM) status was reported as HLA 9/10 MM (62%, n=1462/2360), HLA 7/8 MM (26%, n=612/2360), HLA 8/10 MM (5.7%, n=136/2360), HLA 6/8 MM (5.7%, n=134/2360), and 3 or higher HLA MM (0.7%, n=16/2360) of the patients ( 19 , 21 – 23 , 28 , 34 ). Six studies (n=1068) specified the type of allele mismatch (MM) as follows: HLA-A MM in 26.3% (n=281/1068), HLA-B MM in 11.9% (n=127/1068), HLA-C MM in 34.2% (n=366/1068), HLA-DRB1 MM in 11.1% (n=119/1068), HLA-DQB1 MM in 17.3% (n=185/1068), and HLA-DPB1 MM in 29.6% (n=317/1068) of the patients ( 21 , 25 , 30 , 31 , 34 , 35 ) ( Table 1 )…”

“…The graft source was BM in 17% (n=546/3169) and PBSC in 82% (n=2623/3169) of the recipients ( 16 , 19 – 32 ). The median time to transplant from hematologic diagnosis was 10 (1-247) months ( 20 , 22 – 24 , 28 , 30 ), and median follow-up time was 35.1 (0.4-135.6) months ( 16 , 20 – 32 ). The pooled OS was 57.5% (95% CI 0.50-0.64, I 2 = 92%, n=1377/2539) at one year ( 19 – 25 , 28 , 30 – 32 ), while the pooled OS at three years was 44.2% (95% CI 0.35.2-0.52, I 2 = 92%, n=787/1952) ( 19 , 21 , 22 , 24 , 25 , 28 , 30 , 31 ).…”

“…The median time to transplant from hematologic diagnosis was 10 (1-247) months ( 20 , 22 – 24 , 28 , 30 ), and median follow-up time was 35.1 (0.4-135.6) months ( 16 , 20 – 32 ). The pooled OS was 57.5% (95% CI 0.50-0.64, I 2 = 92%, n=1377/2539) at one year ( 19 – 25 , 28 , 30 – 32 ), while the pooled OS at three years was 44.2% (95% CI 0.35.2-0.52, I 2 = 92%, n=787/1952) ( 19 , 21 , 22 , 24 , 25 , 28 , 30 , 31 ). The pooled PFS was 41.5% (95% CI 0.33-0.49 I 2 = 95% n=1183/3086) at a median follow-up of 2.7 (1-6) years ( 16 , 19 – 24 , 27 – 32 ).…”