Similar outcomes after haploidentical transplantation with post-transplant cyclophosphamide versus HLA-matched transplantation: a meta-analysis of case-control studies.

Zhenyang Gu,Chunji Gao,Zhe Gao,Lan Luo,Li Wang,Jon C Aster,Wenrong Huang,Nan Yang,Meng Li,Lixun Guan,Qingyi Wang,Feiyan Wang,Shasha Zhao,Daihong Liu,Lei Yuan

doi:10.18632/oncotarget.18862

Abstract

BackgroundOutcomes of haploidentical hematopoietic cell transplantation (haplo-HCT) with post-transplant cyclophosphamide (PT-Cy) have greatly improved. It remains unknown whether haplo-HCT with PT-Cy was associated with poor outcomes when compared with HLA-matched HCT. To address this issue, we performed a meta-analysis to compare outcomes of haplo-HCT with PT-Cy with those of HLA-matched HCT.MethodsA systematic search for case-control studies were performed in PubMed, Embase and Cochrane Library databases. Using a random model, the risk ratios (RRs) and 95% confidence intervals (95% CI) were pooled for the final analysis.ResultsNine case-control studies including 2258 patients (827 patients in the haplo-HCT with PT-Cy group, 748 controls from HLA-matched related donors (MRD), and 683 controls from HLA-matched unrelated donors (MUD)) met the inclusion criteria. No differences were found between haplo-HCT with PT-Cy and HLA-matched HCT with regard to acute graft-versus-host-disease (GVHD), non-relapse mortality, relapse, progression free survival and overall survival. However, haplo-HCT with PT-Cy was found to be associated with a lower incidence of moderate to severe chronic GVHD (Haplo vs MRD: RR=0.54; 95% CI=0.39-0.75; Haplo vs MUD: RR=0.70; 95% CI=0.56-0.88).ConclusionsThe results of this meta-analysis suggest that haplo-HCT with PT-Cy can achieve comparable outcomes with those of HLA-matched HCT. Haploidentical donors can be a feasible and valid alternative when conventional HLA-matched donors are unavailable.

Highlights

Despite rapid progress in development of targeted therapy, many hematologic malignancies remain incurable with conventional or targeted therapies
The approximate 100-day incidence of Grade II to IV aGVHD (RR=1.13, 95% confidence intervals (95% CI)=0.63 to 2.02; Figure 2A), and Grade III to IV aGVHD (RR=0.98, 95% CI=0.52 to 1.83; Figure 3A) were similar between halo-hematopoietic cell transplantation (HCT) with post-transplant cyclophosphamide (PT-Cy) and the matched related www.impactjournals.com/oncotarget donors (MRD) group
The approximate 2-year non-relapse mortality (NRM) in the haplo-HCT with PT-Cy group was similar to those in the HLA-matched control group (Haplo vs MRD: risk ratios (RRs)=0.99, 95% CI=0.73 to 1.35; Figure 5A; haplo vs matched unrelated donors (MUD): RR=0.83, 95% CI=0.62 to 1.09; Figure 5B)

Summary

Introduction

Despite rapid progress in development of targeted therapy, many hematologic malignancies remain incurable with conventional or targeted therapies. Allogeneic hematopoietic cell transplantation (allo-HCT) remains an effective treatment for most hematologic malignancies. The unavailability of HLA-matched related www.impactjournals.com/oncotarget donors (MRD) and HLA-matched unrelated donors (MUD) has greatly limited the widespread application of allo-HCT. Several alternative donors such as haploidentical related donors, mismatched unrelated donors, and umbilical cord blood, are often used for patients without an HLA-matched donor. Outcomes of haploidentical hematopoietic cell transplantation (haplo-HCT) with post-transplant cyclophosphamide (PT-Cy) have greatly improved. It remains unknown whether haplo-HCT with PT-Cy was associated with poor outcomes when compared with HLA-matched HCT.

Methods

Results

Conclusion