Department of Hematology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, 3 Zhigongxinjie Street, Taiyuan, 030013, People's Republic of China.
Ann Hematol. 2023 Sep;102(9):2565-2587. doi: 10.1007/s00277-023-05339-7. Epub 2023 Jul 13.
This meta-analysis was to evaluate the outcome of haploidentical hematopoietic stem cell transplantation (Haplo-HSCT) for aplastic anemia (AA) compared with matched related donor (MRD)-HSCT, matched unrelated donor (MUD)-HSCT, and immunosuppressive therapy (IST). Pubmed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, and VIP databases were searched for relevant studies from inception to 22 June 2022. Relative risk (RR) was used to indicate the effect indicator, with a 95% confidence interval (CI) being applied to express the effect size. A subgroup analysis based on the literature quality (low, fair, and high) was applied. Totally, 25 studies were included in this study, comprising 2252 patients. Our findings demonstrated no difference between Haplo-HSCT and MRD-HSCT in 1-, 2-, and 3-year overall survival (OS), failure-free survival (FFS), and engraftment. However, Haplo-HSCT had higher incidences of II-IV acute graft-versus-host disease (aGVHD), chronic GVHD (cGVHD), and cytomegalovirus infection. There were no differences in 3- and 5-year OS, 3-year FFS, platelet engraftment, graft failure (GF), II-IV grade of aGVHD, and complication between Haplo-HSCT and MUD-HSCT; however, Haplo-HSCT had a lower incidence of cGVHD. Compared with IST, Haplo-HSCT had a higher 3-year FFS and 3- and 6-month response rate. However, there were no differences in 3- and 5-year OS, and 12-month response rate between Haplo-HSCT and IST. This study suggests that Haplo-HSCT may be a realistic therapeutic option for AA, which may provide a reference for decision-making.
这项荟萃分析旨在评估单倍体造血干细胞移植（haplo-HSCT）治疗再生障碍性贫血（AA）的疗效，与匹配相关供体（MRD）-HSCT、匹配无关供体（MUD）-HSCT 和免疫抑制治疗（IST）相比。从建库到 2022 年 6 月 22 日，我们在 PubMed、Embase、Cochrane 图书馆、Web of Science、CNKI、万芳和 VIP 数据库中搜索了相关研究。使用相对风险（RR）表示效应指标，95%置信区间（CI）用于表示效应大小。根据文献质量（低、中、高）进行了亚组分析。本研究共纳入 25 项研究，共 2252 例患者。研究结果显示，haplo-HSCT 与 MRD-HSCT 在 1、2、3 年的总生存率（OS）、无失败生存率（FFS）和植入方面无差异。然而，haplo-HSCT 的 II-IV 级急性移植物抗宿主病（aGVHD）、慢性移植物抗宿主病（cGVHD）和巨细胞病毒感染发生率更高。在 3 年和 5 年 OS、3 年 FFS、血小板植入、移植物失败（GF）、II-IV 级 aGVHD 和并发症方面，haplo-HSCT 与 MUD-HSCT 无差异；然而，haplo-HSCT 的 cGVHD 发生率较低。与 IST 相比，haplo-HSCT 具有更高的 3 年 FFS 和 3 个月和 6 个月的反应率。然而，haplo-HSCT 与 IST 在 3 年和 5 年 OS 以及 12 个月的反应率方面无差异。这项研究表明，haplo-HSCT 可能是 AA 的一种现实治疗选择，可为决策提供参考。
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