Abstract
BackgroundMost likely due to the availability of potential stem cell sources, there appears to be a growing usage of haploidentical (haplo) donors for cases of acute lymphoblastic leukemia involving high-risk features or relapse. Patients and MethodsThis study compared the outcomes of stem cell transplantations (SCTs) using haplo and other stem cell sources, namely, matched sibling donors (MSDs), matched unrelated donors (MUDs), and cord blood transplantations (CBTs). Literature searches were conducted of the MEDLINE and Embase databases from inception to December 2020. ResultsTwenty-eight studies were examined (17 retrospective and 11 prospective). There were no significant differences in the overall survival of haplo and those of the other stem-cell sources. For haplo versus matched donor (MSD or MUD), the pooled odds ratio (OR) was 0.94 (95% CI, 0.79-1.12; I2, 22%); while for haplo versus CBT, the OR was 1.24 (95% CI, 0.78-1.96; I2, 28%). The cumulative relapse incidence was significantly higher for MSD than haplo (OR, 0.69; 95% CI, 0.48-0.99; I2, 48%). Both grade II-IV acute and long-term graft-versus-host disease (GVHD) were significantly higher for haplo than MSD (OR, 1.78; 95% CI, 1.15-2.74; I2, 28%; and OR, 1.33; 95% CI, 1.00-1.77; I2, 14%, respectively). The other clinical outcomes did not demonstrate any statistical differences. ConclusionThe outcomes of patients treated with haplo-SCT appear comparable with those of the SCTs using other sources. The higher probability of developing GVHD supports the need for a novel method to harness T-cell alloreactivity
Highlights
Most likely due to the availability of potential stem cell sources, there appears to be a growing usage of haploidentical donors for cases of acute lymphoblastic leukemia involving high-risk features or relapse
This systematic review and meta-analysis compared the outcomes of stem cell transplantations (SCT) using haplo and other stem cell sources
The overall survival was comparable between haplo-SCT and other stem-cell sources-SCT
Summary
Most likely due to the availability of potential stem cell sources, there appears to be a growing usage of haploidentical (haplo) donors for cases of acute lymphoblastic leukemia involving high-risk features or relapse. In adult ALL patients, the rate is 50%–60% even if they are treated with the pediatric-inspired regimen[2,3] This indicates the need for treatments with improved efficacies and suggests that a cure may not rely solely on the use of chemotherapy. Allogeneic stem cell transplantation (ASCT) may be required for individuals with relapsed or refractory diseases; the indications for ASCT have been broadened to encompass first complete remissions in adult patients harboring high-risk features[4] and, to a minor extent, infant ALL harboring a mixed-lineage leukemia gene rearrangement[5]. The major disadvantage of haplo-SCTs is the alloreactivity of T-cells This results in graft rejection and graft-versus-host disease (GVHD), which may impact the survival of patients. The present study aimed to quantify and compare the following factors related to patients treated with haplo-SCTs and other types of SCT: overall survival (OS); leukemic free survival (LFS); non-relapse mortality (NRM); cumulative incidence of relapse (CIR); graftversus-host disease (GVHD), including acute grades II–IV GVHD (aGVHD) and chronic GVHD (cGVHD); and GVHD-free, relapse-free survival (i.e., GRFS)
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