Similar outcomes after haploidentical transplantation with post-transplant cyclophosphamide versus HLA-matched transplantation: a meta-analysis of case-control studies
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Zhenyang Gu1,2,*, Li Wang1,3,*, Lei Yuan1,*, Wenrong Huang1, Meng Li1, Lixun Guan1, Qingyi Wang4, Zhe Gao1, Shasha Zhao1, Lan Luo1, Feiyan Wang1, Nan Yang1, Daihong Liu1, Jon C. Aster2 and Chunji Gao1
1Department of Hematology, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
2Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
3Department of Hematology and Oncology, Laoshan Branch, No. 401 Hospital of Chinese PLA, Qingdao, China
4Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, MA, USA
*These authors have contributed equally to this work
Chunji Gao, email: [email protected]
Jon C. Aster, email: [email protected]
Keywords: post-transplant cyclophosphamide, haploidentical, hematopoietic cell transplantation, HLA-matched, similar outcomes
Received: January 17, 2017 Accepted: June 02, 2017 Published: June 29, 2017
Background: 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. To address this issue, we performed a meta-analysis to compare outcomes of haplo-HCT with PT-Cy with those of HLA-matched HCT.
Methods: A 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.
Results: Nine 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).
Conclusions: The 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.
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