The effect of different types of allogeneic hematopoietic stem cell transplantation donors in Philadelphia chromosome-positive acute lymphoblastic leukemia during tyrosine kinase inhibitors era: A systematic review and meta-analysis.

Abstract

e19022 Background: Matched donor (MD) allogeneic hematopoietic stem cell transplantation (allo-HSCT) is currently the preferred choice of treatment in Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) who achieve complete remission. However, the unavailability of the appropriate donor remains a problem for a large group of patients. This systematic review and meta-analysis were conducted to investigate the effect of allo-HSCT from different types of the donor in Ph+ ALL patients who received tyrosine kinase inhibitors (TKIs). Methods: Studies from EMBASE and MEDLINE databases were identified from inception to December 2020 using search terms related to “Ph+ ALL” and “HSCT.” Eligible studies must be either randomized controlled trials or cohort studies with Ph+ ALL patients who received a TKI and allo-HSCT. The primary outcome of interest, consisting of overall survival (OS) or relapse-free survival (RFS), must be reported as the number of patients in each donor type. The Hantel-Maenszel method was implemented for combining effect estimates and associated 95% confidence interval (CI) from each. Results: Thirteen cohort studies were included for the meta-analysis. Haploidentical (HID)-HSCT for Ph+ ALL patients resulted in superior RFS than MD-HSCT with pooled odds ratio (OR) 1.64 (95%CI, 1.07–2.53; I2=0%) while had comparable OS (pooled OR 1.11 (95%CI, 0.74–1.69; I2=0%). Although HID-HSCT had significantly less relapse rate compared to the other group (pooled OR 0.53; 95%CI, 0.33–0.86; I2=0%), it also carried increased risks of graft-versus-host disease (GVHD) (pooled OR of acute GVHD rate 2.12; 95%CI, 1.05–4.31; I2=0% and chronic GVHD rate 1.63; 95%CI, 1.01–2.62; I2=0%). Matched sibling-HSCT, matched unrelated-HSCT, and cord blood-HSCT had the comparable OS and RFS to HID-HSCT. Conclusions: This systematic review and meta-analysis showed that HID-HSCT is as effective as MD-HSCT, and appears to be safe to implement in Ph+ ALL patients which could become useful in the case where there was no available donor.