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Meta-Analysis
. 2020 Jan-Dec:29:963689720975397.
doi: 10.1177/0963689720975397.

Comparison of Survival Between Autologous and Allogeneic Stem Cell Transplantation in Patients with Relapsed or Refractory B-Cell Non-Hodgkin Lymphoma: A Meta-Analysis

Jianhong Wang  1 , Xiaohui Duan  1 , Lijie Yang  1 , Xiangxiang Liu  1 , Caixia Hao  1 , Hongjuan Dong  1 , Hongtao Gu  1 , Hailong Tang  1 , Baoxia Dong  1 , Tao Zhang  1 , Guangxun Gao  1 , Rong Liang  1
Affiliations
Meta-Analysis

Comparison of Survival Between Autologous and Allogeneic Stem Cell Transplantation in Patients with Relapsed or Refractory B-Cell Non-Hodgkin Lymphoma: A Meta-Analysis

Jianhong Wang et al. Cell Transplant. 2020 Jan-Dec.

Abstract

This study aimed to compare the efficacy of allogeneic stem cell transplantation (allo-SCT) versus autologous SCT (auto-SCT) in patients with relapsed or refractory B-cell non-Hodgkin lymphoma (B-NHL). Medline, CENTRAL, and EMBASE databases through December 31, 2019 were searched. The primary endpoints were overall survival (OS) and progression-free survival (PFS) rates. The secondary outcomes include transplant-related mortality (TRM), event-free survival, relapse/or progression, and nonrelapse mortality (NRM). The 18 retrospective studies enrolled 8,058 B-NHL patients (allo-SCT = 1,204; auto-SCT = 6,854). The OS was significantly higher in patients receiving auto-SCT than allo-SCT (pooled odds ratio [OR]: 1.69, 95% confidence interval [CI]: 1.29 to 2.22, P < 0.001), but no significant difference was found in PFS (pooled OR: 0.98, 95% CI: 0.69 to 1.38, P = 0.891). Auto-SCT patients also had lower TRM and NRM (TRM: OR = 0.23, P < 0.001; NRM: OR = 0.16, P < 0.001), but higher relapse or progression rate (OR = 2.37, P < 0.001) than allo-SCT patients. Subgroup analysis performed for different grades and subtypes of B-NHL showed higher OS in auto-SCT patients with high-grade B-NHL and diffused large B-cell lymphoma (DLBCL). There was, nevertheless, higher PFS in allo-SCT patients with low-grade B-NHL and follicular lymphoma (FL), and lower PFS in allo-SCT patients with DLBCL than their auto-SCT counterparts. In conclusion, the meta-analysis demonstrated that relapsed or refractory B-NHL patients who received auto-SCT have improved OS than those treated with allo-SCT, especially among those with DLBCL, but lower PFS among those with FL. However, the study is limited by a lack of randomized trials, patients' heterogeneity, and possible selection bias.

Keywords: allogeneic; autologous; meta-analysis; non-Hodgkin lymphoma; stem cell transplantation.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow diagram for study selection.
Figure 2.
Figure 2.
Forest plot comparing (A) the OS rate, (B) the PFS rate, of participants receiving autologous stem cell transplantation (“autologous”) or allogeneic stem cell transplantation (“allogeneic”). CI: confidence interval; OS: overall survival; PFS: progression-free survival.
Figure 3.
Figure 3.
Risk-of-bias assessment of the included studies. Quality assessments of each included study are summarized as the “risk of bias summary” (A). Green circles indicate that the factor was reported with low risk of bias; red circles indicate that the factor was reported with high risk of bias. The percentages of bias across all of the included studies are shown in a “risk of bias” graph (B).
Figure 4.
Figure 4.
Funnel plot with Egger’s test in publication bias analysis regarding the major outcomes, OS rate (A), and PFS rate (B). OS: overall survival; PFS: progression-free survival.
See this image and copyright information in PMC

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