Chang Geng1, Xinjian Liu2, Miao Chen1, Chen Yang1, Bing Han3. 1. Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China. 2. Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Institute of Hematology of Henan Province, 127 Dongming Road, Zhengzhou, China. 3. Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China. Electronic address: hanbing_li@sina.com.
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.
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.
Authors: Raheel Iftikhar; Parvez Ahmad; Regis de Latour; Carlo Dufour; Antonio Risitano; Naeem Chaudhri; Ali Bazarbachi; Josu De La Fuente; Britta Höchsmann; Syed Osman Ahmed; Usama Gergis; Alaa Elhaddad; Constantijn Halkes; Bassim Albeirouti; Sultan Alotaibi; Austin Kulasekararaj; Hazzaa Alzahrani; Tarek Ben Othman; Simone Cesaro; Ali Alahmari; Rawad Rihani; Salem Alshemmari; Amir Ali Hamidieh; Mohamed-Amine Bekadja; Jakob Passweg; Murtadha Al-Khabori; Walid Rasheed; Andrea Bacigalupo; Qamar-Un-Nisa Chaudhry; Per Ljungman; Judith Marsh; Riad El Fakih; Mahmoud Aljurf Journal: Bone Marrow Transplant Date: 2021-05-19 Impact factor: 5.483