Effects of different types of allogeneic hematopoietic stem cell transplantation donors on Philadelphia chromosome-positive acute lymphoblastic leukemia during the tyrosine kinase inhibitor era: A systematic review and meta-analysis

Ben Ponvilawan, Department of Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Weerapat Owattanapanich, Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Nipith Charoenngam, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Smith Kungwankiattichai, Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, ThailandFollow

Abstract

Background: Matched donor (MD) allogeneic hematopoietic stem cell transplantation (allo- HSCT) is currently the preferred choice of treatment for Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) patients who have achieved complete remission. This systematic review and meta-analysis was conducted to investigate the effects of allo-HSCTs from different donor types for Ph+ ALL patients who received tyrosine kinase inhibitors (TKIs). Methods: Studies in EMBASE and MEDLINE between inception and December 2020 were identified using search terms related to ‘‘Ph+ ALL” and ‘‘HSCT.” Eligible studies were studies with Ph+ ALL patients who received a TKI and allo-HSCT. The primary outcomes of interest—the overall survival (OS) or relapse-free survival (RFS)—needed to be reported. The Mantel–Haenszel method was used to combine the effect estimates and associated 95% confidence intervals (CIs) of each donor type.

Results: Fourteen cohort studies were identified for the meta-analysis. Haploidentical (HID)- HSCT for Ph+ ALL patients resulted in a superior RFS to MD-HSCT, with a pooled odds ratio (OR) of 1.57 (95% CI, 1.05–2.32; I2 = 0%). However, HID-HSCT and MD-HSCT had comparable OS. Furthermore, HID-HSCT group had a significantly lower relapse rate than MD-HSCT group. On the other hand, the risks of graft-versus-host disease (GvHD) were higher for HID-HSCT and pooled OR of chronic GvHD rate. The OS and RFS of matched sibling-HSCT, matched unrelated-HSCT, and cord blood-HSCT were comparable with those of HID-HSCT. Conclusion: This systematic review and meta-analysis showed that HID-HSCT is as effective as MD-HSCT in Ph+ ALL patients.

Recommended Citation

Ponvilawan, Ben; Owattanapanich, Weerapat; Charoenngam, Nipith; and Kungwankiattichai, Smith (2023) "Effects of different types of allogeneic hematopoietic stem cell transplantation donors on Philadelphia chromosome-positive acute lymphoblastic leukemia during the tyrosine kinase inhibitor era: A systematic review and meta-analysis," Hematology/Oncology and Stem Cell Therapy: Vol. 16 : Iss. 3 , Article 4.
Available at: https://doi.org/10.1016/j.hemonc.2021.09.007