HLA-haploidentical vs matched-sibling hematopoietic cell transplantation: a systematic review and meta-analysis

Abstract

HLA haploidentical hematopoietic cell transplantation (haplo-HCT) using posttransplantation cyclophosphamide (PT-Cy) is an alternative strategy when a matched sibling donor (MSD) is not available. We performed a systematic review and meta-analysis to compare the outcomes of MSD vs haplo-HCT. Eleven studies (1410 haplo-HCT and 6396 MSD recipients) were meta-analyzed. All studies were retrospective and high quality, and 9 were multicenter. Haplo-HCT was associated with ~50% lower risk of chronic graft-versus-host disease (GVHD) (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.41-0.74), but higher risk of nonrelapse mortality (HR, 1.36; 95% CI, 1.12-1.66). Relapse, survival, acute GVHD, and GVHD-free relapse-free survival were not significantly different between the groups. Deciphering the relative contribution of PT-Cy and HLA disparity to the observed outcome differences between the groups requires further research.

Figure 1.

Random-effects meta-analysis. Detailed results for cGVHD (A), NRM (B), DFS (C), and grade II-IV acute GVHD (D). (E) A summary of other outcomes. The study by Robinson et al was considered separately for patient groups < 55 years of age (first occurrence in each plot) and ≥55 years of age (second occurrence in each plot) years. CI, confidence interval; HR, hazard ratio.