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. 2017 Jun 29;8(38):63574-63586.
doi: 10.18632/oncotarget.18862. eCollection 2017 Sep 8.

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

Zhenyang Gu #  1   2 , Li Wang #  1   3 , Lei Yuan #  1 , Wenrong Huang  1 , Meng Li  1 , Lixun Guan  1 , Qingyi Wang  4 , Zhe Gao  1 , Shasha Zhao  1 , Lan Luo  1 , Feiyan Wang  1 , Nan Yang  1 , Daihong Liu  1 , Jon C Aster  2 , Chunji Gao  1
Affiliations

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

Zhenyang Gu et al. Oncotarget. .

Abstract

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.

Keywords: HLA-matched; haploidentical; hematopoietic cell transplantation; post-transplant cyclophosphamide; similar outcomes.

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Conflict of interest statement

CONFLICTS OF INTEREST The authors declare that they have no competing interests

Figures

Figure 1
Figure 1. Flow chart of the systematic search used in this study
MRD: HLA-matched related donors, MUD: HLA-matched unrelated donors, EBMT: European Group for Blood and Marrow Transplantation, IBMTR: the International Bone Marrow Transplant Registry (IBMTR) databases.
Figure 2
Figure 2. Forest plot and meta-analysis of the approximate 100-day incidence of Grade II to IV aGVHD
The incidence rates were similar between halo-HCT with PT-Cy and HLA-matched HCT. Haplo versus MRD (A), Haplo versus MUD (B). aGVHD: acute graft-versus-host disease, HCT: hematopoietic cell transplantation, PT-Cy: post-transplant cyclophosphamide, haplo: HLA-haploidentical, MRD: HLA-matched related donor, MUD: HLA-matched unrelated donor, RR: risk ratio, CI: confidence interval.
Figure 3
Figure 3. Forest plot and meta-analysis of the approximate 100-day incidence of Grade III to IV aGVHD
The incidence rates were similar between haplo-HCT with PT-Cy and HLA-matched HCT. Haplo versus MRD (A), Haplo versus MUD (B). aGVHD: acute graft-versus-host disease, HCT: hematopoietic cell transplantation, PT-Cy: post-transplant cyclophosphamide, haplo: HLA-haploidentical, MRD: HLA-matched related donor, MUD: HLA-matched unrelated donor, RR: risk ratio, CI: confidence interval.
Figure 4
Figure 4. Forest plot and meta-analysis of the approximate 2-year incidence of moderate to severe cGVHD
The incidence rate after haplo-HCT with PT-Cy was significantly lower than that of HLA-matched HCT. Haplo versus MRD (A), Haplo versus MUD (B). cGVHD: chronic graft-versus-host disease, HCT: hematopoietic cell transplantation, PT-Cy: post-transplant cyclophosphamide, haplo: HLA-haploidentical, MRD: HLA-matched related donor, MUD: HLA-matched unrelated donor, RR: risk ratio, CI: confidence interval.
Figure 5
Figure 5. Forest plot and meta-analysis of the approximate 2-year non-relapse mortality
It was similar between haplo-HCT with PT-Cy and HLA-matched HCT. Haplo versus MRD (A), Haplo versus MUD (B). HCT: hematopoietic cell transplantation, PT-Cy: post-transplant cyclophosphamide, haplo: HLA-haploidentical, MRD: HLA-matched related donor, MUD: HLA-matched unrelated donor, RR: risk ratio, CI: confidence interval.
Figure 6
Figure 6. Forest plot and meta-analysis of the approximate 2-year relapse rate
It was similar between haplo-HCT with PT-Cy and HLA-matched HCT. Haplo versus MRD (A), Haplo versus MUD (B). HCT: hematopoietic cell transplantation, PT-Cy: post-transplant cyclophosphamide, haplo: HLA-haploidentical, MRD: HLA-matched related donor, MUD: HLA-matched unrelated donor, RR: risk ratio, CI: confidence interval.
Figure 7
Figure 7. Forest plot and meta-analysis of the approximate 3-year progression free survival. It was similar between haplo-HCT with PT-Cy and HLA-matched HCT
Haplo versus MRD (A), Haplo versus MUD (B). HCT: hematopoietic cell transplantation, PT-Cy: post-transplant cyclophosphamide, haplo: HLA-haploidentical, MRD: HLA-matched related donor, MUD: HLA-matched unrelated donor, RR: risk ratio, CI: confidence interval.
Figure 8
Figure 8. Forest plot and meta-analysis of the approximate 3-year overall survival
It was similar between haplo-HCT with PT-Cy and HLA-matched HCT. Haplo versus MRD (A), Haplo versus MUD (B). HCT: hematopoietic cell transplantation, PT-Cy: post-transplant cyclophosphamide, haplo: HLA-haploidentical, MRD: HLA-matched related donor, MUD: HLA-matched unrelated donor, RR: risk ratio, CI: confidence interval.
See this image and copyright information in PMC

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