Gu Zhenyang, Wang Li, Yuan Lei, Huang Wenrong, Li Meng, Guan Lixun, Wang Qingyi, Gao Zhe, Zhao Shasha, Luo Lan, Wang Feiyan, Yang Nan, Liu Daihong, Aster Jon C, Gao Chunji
Department of Hematology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Oncotarget. 2017 Jun 29;8(38):63574-63586. doi: 10.18632/oncotarget.18862. eCollection 2017 Sep 8.
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.
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.
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).
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.
采用移植后环磷酰胺（PT-Cy）的单倍体造血细胞移植（haplo-HCT）的疗效已得到显著改善。与HLA匹配的造血细胞移植相比，PT-Cy的单倍体造血细胞移植是否会导致不良预后仍不清楚。为解决这一问题，我们进行了一项荟萃分析，以比较PT-Cy的单倍体造血细胞移植与HLA匹配的造血细胞移植的疗效。
在PubMed、Embase和Cochrane图书馆数据库中对病例对照研究进行系统检索。采用随机模型，汇总风险比（RRs）和95%置信区间（95%CI）进行最终分析。
9项病例对照研究共纳入2258例患者（PT-Cy的单倍体造血细胞移植组827例患者，HLA匹配的相关供体（MRD）对照组748例，HLA匹配的无关供体（MUD）对照组683例）符合纳入标准。在急性移植物抗宿主病（GVHD）、非复发死亡率、复发率、无进展生存期和总生存期方面，PT-Cy的单倍体造血细胞移植与HLA匹配的造血细胞移植之间未发现差异。然而，发现PT-Cy的单倍体造血细胞移植与中重度慢性GVHD的发生率较低相关（单倍体与MRD：RR=0.54；95%CI=0.39-0.75；单倍体与MUD：RR=0.70；95%CI=0.56-0.88）。
这项荟萃分析的结果表明PT-Cy的单倍体造血细胞移植可以取得与HLA匹配的造血细胞移植相当的疗效。当无法获得传统的HLA匹配供体时，单倍体供体可以是一种可行且有效的替代方案。
