Comparison of frontline treatment with intensive immunosuppression therapy and HLA-haploidentical hematopoietic stem cell transplantation for young patients with severe aplastic anemia - A meta analysis

Leuk Res. 2020 Jan:88:106266. doi: 10.1016/j.leukres.2019.106266. Epub 2019 Nov 7.

Abstract

Aim: To compare the survivals and treatment related complications between immunosuppression therapy (IST) and haploidentical hematopoietic stem cell transplantation (haplo-HSCT) on children and young adults with severe aplastic anemia (SAA) in East Asia during the last 10 years.

Methods: After looking through Pubmed, Embase, Web of Science and Wanfang Data, a total of 491 patients from 7 retrospective studies conducted in East-Asia were included for meta-analysis based on Stata program. Publication bias was measured by Begger and Egger tests. 1/3/5/10 years overall survivals (OS), failure free survivals (FFS), incidence rates of adverse events and their 95% confidence intervals (CI) were pooled and compared.

Results: There was no difference of 1/3/5/10 years OS between IST group and haplo-HSCT group, but the 1/3/5/10 years FFS were significantly better in haplo-HSCT group compared with IST group (p < 0.01). However, higher incidence of infections was observed in haplo-HSCT group compared with IST group (76% versus 45%, p < 0.001). The pooled estimates for acute graft versus host disease (aGVHD) and chronic graft versus host disease (cGVHD) were 54% (95% Cl, 43%～64%) and 43% (95% CI, 18%～68%), respectively for haplo-HSCT group. Among them 38% (95%CI, 22%～54%) was grade III aGVHD and 11% (95% Cl, 0%～22%) was grade III-IV aGVHD. Death causes included severe infection, bleeding in IST group and infection, GVHD in haplo-HSCT group.

Conclusions: The long-term survivals were similar for young patients with SAA who received IST or haplo-HSCT as the frontline treatment. The haplo-HSCT group showed a better FFS, on the other hand, had higher incidence of infection and GVHD.

Keywords: Haploidentical hematopoietic stem cell transplantation; Immunosuppression therapy; Meta-analysis; Severe aplastic anemia.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Age of Onset
  • Anemia, Aplastic / epidemiology
  • Anemia, Aplastic / pathology
  • Anemia, Aplastic / therapy*
  • Child
  • Graft vs Host Disease / epidemiology
  • Graft vs Host Disease / etiology
  • Hematopoietic Stem Cell Transplantation* / methods
  • Hematopoietic Stem Cell Transplantation* / statistics & numerical data
  • Histocompatibility Testing
  • Humans
  • Immunosuppression Therapy / methods*
  • Immunosuppression Therapy / statistics & numerical data
  • Immunosuppressive Agents / therapeutic use
  • Incidence
  • Neoadjuvant Therapy / methods*
  • Neoadjuvant Therapy / statistics & numerical data
  • Retrospective Studies
  • Severity of Illness Index
  • Survival Analysis
  • Transplantation Conditioning / methods*
  • Transplantation Conditioning / statistics & numerical data
  • Transplantation, Haploidentical* / methods
  • Transplantation, Haploidentical* / statistics & numerical data
  • Treatment Outcome
  • Young Adult

Substances

  • Immunosuppressive Agents