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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 01; 88:106266.LR

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.

Authors+Show Affiliations

Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Institute of Hematology of Henan Province, 127 Dongming Road, Zhengzhou, China.Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.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.

Pub Type(s)

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

Language

eng

PubMed ID

31743865

Citation

Geng, Chang, et al. "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." Leukemia Research, vol. 88, 2020, p. 106266.
Geng C, Liu X, Chen M, et al. 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;88:106266.
Geng, C., Liu, X., Chen, M., Yang, C., & Han, B. (2020). 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. Leukemia Research, 88, 106266. https://doi.org/10.1016/j.leukres.2019.106266
Geng C, et al. 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;88:106266. PubMed PMID: 31743865.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Geng,Chang, AU - Liu,Xinjian, AU - Chen,Miao, AU - Yang,Chen, AU - Han,Bing, Y1 - 2019/11/07/ PY - 2019/09/07/received PY - 2019/10/14/revised PY - 2019/10/28/accepted PY - 2019/11/20/pubmed PY - 2020/7/15/medline PY - 2019/11/20/entrez KW - Haploidentical hematopoietic stem cell transplantation KW - Immunosuppression therapy KW - Meta-analysis KW - Severe aplastic anemia SP - 106266 EP - 106266 JF - Leukemia research JO - Leuk. Res. VL - 88 N2 - 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. SN - 1873-5835 UR - https://www.unboundmedicine.com/medline/citation/31743865/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_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0145-2126(19)30711-8 DB - PRIME DP - Unbound Medicine ER -