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Peripheral blood stem cell transplantation vs. bone marrow transplantation for aplastic anemia: a systematic review and meta-analysis
Zhang, Z., Zhou, X., Cheng, Z., Hu, Y.
Frontiers in medicine. 2023;10:1289180
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Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) is an effective treatment for aplastic anemia. Recently, peripheral blood stem cell transplantation (PBSCT) has gradually replaced traditional bone marrow transplantation (BMT). However, which graft source has a better therapeutic effect and prognosis for aplastic anemia (AA) remains unclear. Therefore, we conducted this systematic review and meta-analysis. METHODS We systematically searched PubMed, EMBASE, and the Cochrane Library without language limitations for studies using PBSCT or BMT for AA. Data were analyzed using the Open Meta-Analyst. RESULTS We identified 17 of 18,749 studies, including seven comparative reports and nine single-arm reports, with a total of 3,516 patients receiving HSCT (1,328 and 2,188 patients received PBSCT and BMT, respectively). The outcomes of the comparative studies showed similar 5-year overall survival [OS; relative risk (RR) = 0.867; 95% confidence interval (CI), 0.747-1.006], similar transplant-related mortality (RR = 1.300; 95%CI, 0.790-2.138), graft failure rate (RR = 0.972; 95%CI, 0.689-1.372) between the PBSCT group and the BMT group, while the PBSCT group had a significantly higher incidence of chronic graft-versus-host disease (GVHD; RR = 1.796; 95% CI, 1.571-2.053) and a higher incidence of grade IV acute GVHD (RR = 1.560; 95% CI, 1.341-1.816) compared to the BMT group. The outcomes of single-arm reports showed similar 3-year OS and incidences of chronic GVHD, acute II-IV GVHD, III-IV GVHD, transplant-related mortality and graft failure rate between PBSCT and BMT. CONCLUSION Before 2010, PBSCT was not superior to BMT in terms of 5-year OS, transplant-related mortality and graft failure rate, but it exhibited a higher risk of both chronic and acute GVHD. After 2010, PBSCT and BMT showed similar 3-year OS, GVHD risks, transplant-related mortality and graft failure rate. PB grafts are more suitable for HSCT of the AA for convenience and pain relief. SYSTEMATIC REVIEW REGISTRATION www.crd.york.ac.uk/PROSPERO/, CRD42023412467.
PICO Summary
Population
Participants with aplastic anaemia enrolled in studies included in systematic review (n=3516, 17 studies: 7 comparative, 10 single arm)
Intervention
Peripheral blood stem cell transplantation (PBSCT group, n=1328)
Comparison
Bone marrow transplantation (BMT group, n=2188)
Outcome
The outcomes of the comparative studies showed similar 5-year overall survival [OS; relative risk (RR) = 0.867; 95% confidence interval (CI), 0.747-1.006], similar transplant-related mortality (RR = 1.300; 95%CI, 0.790-2.138), graft failure rate (RR = 0.972; 95%CI, 0.689-1.372) between the PBSCT group and the BMT group, while the PBSCT group had a significantly higher incidence of chronic graft-versus-host disease (GVHD; RR = 1.796; 95% CI, 1.571-2.053) and a higher incidence of grade IV acute GVHD (RR = 1.560; 95% CI, 1.341-1.816) compared to the BMT group. The outcomes of single-arm reports showed similar 3-year OS and incidences of chronic GVHD, acute II-IV GVHD, III-IV GVHD, transplant-related mortality and graft failure rate between PBSCT and BMT.
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Impact of the Source of Hematopoietic Stem Cells on Immune Reconstitution After Transplantation: A Systematic Review
Sugiyanto, M., Gosal, S., Kosim, A., Tahapary, D. L., Sianipar, I. R.
European journal of haematology. 2023
Abstract
Hematopoietic stem cell (HSC) transplantation's success lies in its ability to induce immune reconstitution. To date, there is no review published to compare the immune reconstitution among the three sources of HSC: umbilical cord blood (UCB), bone marrow (BM), and peripheral blood (PB). The review aims to analyze the kinetic of immune reconstitution among UCB, PB, and BM in HSC transplant patients by focusing on NK cells, B and T lymphocytes, and neutrophils. A systematic review was conducted through five databases, searching for clinical trials and RCTs which analyze the kinetics of immune reconstitution in at least two sources. Selected studies were assessed with Cochrane RoB 2.0. This review included 14 studies, with a total of 2,539 subjects. The PB group achieved the fastest time to neutrophil recovery, while the B-cell count was the highest in the UCB group. The T-cell count is the lowest in the BM group, and the NK-cell count does not differ significantly among the three HSC sources. Among the three sources of HSC, there is no superior HSC source for any immune reconstitution parameter. More studies must be conducted to compare the immune reconstitution and clinical outcomes of all HSC sources in specific diseases. This article is protected by copyright. All rights reserved.
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The efficiency of a continuous versus an intermittent apheresis method for collection of hematopoietic progenitor stem cells: A systematic review
Hobbs, C., Green, H., Fernandez, R.
Journal of clinical apheresis. 2023
Abstract
Peripheral blood hematopoietic progenitor stem cells (HPSCs) are the most common source of stem cells for autologous and allogenic transplantation. Currently, systematic reviews comparing the collection efficiency of a continuous to an intermittent method are lacking despite the existence of primary studies. Therefore, the objective of this review was to synthesize the best available evidence to compare the efficiency of the continuous vs the intermittent method for the collection of hematopoietic progenitor stem cells required for HPC transplantation. A search using MEDLINE, CINAHL, EMBASE, Google scholar, and MedNar for both published and unpublished studies was conducted in December 2021. The systematic review was conducted in accordance with JBI methodology. A critical appraisal of the studies was undertaken by two independent reviewers using the JBI quasi-experimental critical appraisal checklist. A total of six studies were included in the review. The findings of this review demonstrated that there was no statistically significant difference in the collection efficiency, length of procedure time, and total blood volume processed between the continuous and intermittent programs. The evidence suggests that the continuous method is as safe and effective as the intermittent method to collect HPSCs. Until further evidence becomes available clinicians should be guided by the policies of their individual hospitals.
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Allogeneic bone marrow versus peripheral blood stem cell transplantation for hematological malignancies in children: a systematic review and meta-analysis
Shimosato, Y., Tanoshima, R., Tujimoto, S. I., Takeuchi, M., Shiba, N., Kobayashi, T., Ito, S.
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2019
Abstract
Peripheral blood stem cell transplantation (PBSCT) is being increasingly performed as an alternative to bone marrow transplantation (BMT); however, PBSCT has not been proven to have equivalent outcome to BMT. We conducted a meta-analysis to compare survival rates and treatment-related complications between PBSCT and BMT for pediatric hematological malignancy. We searched MEDLINE, EMBASE plus EMBASE classics, and the Cochrane Central Register of Controlled Trials for the terms "hematopoietic stem cell transplantation" AND "allogeneic transplantation" AND "children", including randomized controlled studies and cohort studies without language limitations. We identified seven of 5368 studies for inclusion. The cohorts of these studies comprised 4328 patients, 3185 who underwent BMT and 1143 who underwent PBSCT. Five-year overall survivals were similar in the two groups (PBSCT 56.2%, BMT: 63.5%, RR: 1.17, 95% CI: 0.91-1.52), as were the five-year event-free survivals (PBSCT 49.9%, BMT: 57.2%, RR: 1.14, 95% CI: 0.93-1.39). The incidences of non-relapsed mortality and chronic graft versus host disease were higher in the PBSCT than BMT group (RR: 1.73, 95% CI: 1.50-1.99; RR: 1.55, 95% CI: 1.18-2.03, respectively). This meta-analysis showed that there is insufficient evidence to conclude that peripheral blood stem cells are equivalent to bone marrow. The results indicate that bone marrow can still be a preferred donor source for pediatric hematological malignancies.
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Bone Marrow Versus Peripheral Blood Stem Cell Transplant in Lymphoma: A Systematic Review and Meta-Analysis
Jiang, Y., Zhen, Y., Xu, Q., He, D., Chen, G., Chen, Y.
Experimental and Clinical Transplantation : Official Journal of the Middle East Society for Organ Transplantation. 2018;16(5):596-607
Abstract
OBJECTIVES The choice of whether to use bone marrow or peripheral blood in autologous transplantation remains controversial. Posttransplant relapse and long-term survival are critical issues. MATERIALS AND METHODS Studies that compared bone marrow transplant versus peripheral blood stem cell transplant in lymphoma patients were searched. Our search resulted in 15 studies. RESULTS Pooled data showed contradictory results with no conclusive differences in overall survival (for randomized controlled trials vs nonrandomized controlled trials: hazard ratio = 0.69 vs 1.17; 95% confidence interval, 0.44-1.10 vs 0.90-1.51; and P = .12 vs P = .25), progression-free survival (for randomized controlled trials vs nonrandomized controlled trials: hazard ratio = 0.89 vs 1.14; 95% confidence interval, 0.57-1.38 vs 0.82-1.58; and P = .60 vs P = .43), and relapse rates. However, we observed an overall trend toward lower relapse rate after bone marrow transplant. Lower relapse rate was likely associated with better progression-free survival (P = .052), and lower transplant-related mortality was associated with better overall survival (P = .043). CONCLUSIONS Autologous bone marrow transplant with mobilization should be reconsidered for lymphoma patients to reduce recurrence and improve quality of life. More powered randomized controlled trials are warranted to update our findings.
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Bone marrow versus peripheral blood allogeneic haematopoietic stem cell transplantation for haematological malignancies in adults
Holtick, U., Albrecht, M., Chemnitz, J. M., Theurich, S., Skoetz, N., Scheid, C., von Bergwelt-Baildon, M.
The Cochrane Database of Systematic Reviews. 2014;(4):Cd010189
Abstract
BACKGROUND Allogeneic haematopoietic stem cell transplantation (allo-HSCT) is an established treatment option for many malignant and non-malignant disorders. In the past two decades, peripheral blood stem cells replaced bone marrow as stem cell source due to faster engraftment and practicability. Previous meta-analyses analysed patients treated from 1990 to 2002 and demonstrated no impact of the stem cell source on overall survival, but a greater risk for graft-versus-host disease (GvHD) in peripheral blood transplants. As transplant indications and conditioning regimens continue to change, whether the choice of the stem cell source has an impact on transplant outcomes remains to be determined. OBJECTIVES To assess the effect of bone marrow versus peripheral blood stem cell transplantation in adult patients with haematological malignancies with regard to overall survival, incidence of relapse and non-relapse mortality, disease-free survival, transplant-related mortality, incidence of GvHD and time to engraftment. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 1), MEDLINE (from 1948 to February 2014), trial registries and conference proceedings. The search was conducted in October 2011 and was last updated in February 2014. We did not apply any language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing bone marrow and peripheral blood allogeneic stem cell transplantation in adults with haematological malignancies. DATA COLLECTION AND ANALYSIS Two review authors screened abstracts and extracted and analysed data independently. We contacted study authors for additional information. We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We included nine RCTs that met the pre-defined selection criteria, involving a total of 1521 participants. Quality of data reporting was heterogeneous among the studies. Overall, the risk of bias in the included studies was low.For the primary outcome overall survival, our analysis demonstrated comparable results between bone marrow transplantation (BMT) and peripheral blood stem cell transplantation (PBSCT) (six studies, 1330 participants; hazard ratio (HR) 1.07; 95% CI 0.91 to 1.25; P value = 0.43; high-quality evidence).Disease-free survival (six studies, 1225 participants; HR 1.04; 95% CI 0.89 to 1.21; P value = 0.6; moderate-quality of evidence) and non-relapse or transplant-related mortality (three studies, 758 participants; HR 0.98; 95% CI 0.76 to 1.28; P = 0.91; high-quality evidence) were also comparable between transplantation arms.In the related-donor setting, data from two of eight studies with 211 participants (21%) indicated a higher relapse incidence in participants transplanted with bone marrow stem cells rather than peripheral blood stem cells (HR 2.73; 95% CI 1.47 to 5.08; P value = 0.001). There was no clear evidence of a difference in relapse incidence between transplantation groups in unrelated donors (HR 1.07; 95% CI 0.78 to 1.47; P value = 0.66). The difference between the donor-related and -unrelated subgroups (P-value = 0.008) was considered to be statistically significant.BMT was associated with lower rates of overall and extensive chronic GvHD than PBSCT (overall chronic GvHD: four studies, 1121 participants; HR 0.72; 95% CI 0.61 to 0.85; P value = 0.0001, extensive chronic GvHD: four studies, 765 participants; HR 0.69; 95% CI 0.54 to 0.9; P value = 0.006; moderate-quality evidence for both outcomes). The incidence of acute GvHD grades II to IV was not lower (six studies, 1330 participants; HR 1.03; 95% CI 0.89 to 1.21; P value = 0.67; moderate-quality evidence), but there was a trend for a lower incidence of grades III and IV acute GvHD with BMT than with PBSCT (three studies, 925 participants; HR 0.75; 95% CI 0.55 to 1.02; P value = 0.07; moderate-quality evidence).Times to neutrophil and platelet engraftment were longer with BMT than with PBSCT (neutrophil: five studies, 662 participants; HR 1.96; 95% CI 1.64 to 2.35; P value < 0.00001; platelet: four studies, 333 participants; HR 2.17; 95% CI 1.69 to 2.78; P value < 0.00001). AUTHORS' CONCLUSIONS This systematic review found high-quality evidence that overall survival following allo-HSCT using the current clinical standard stem cell source - peripheral blood stem cells - was similar to that following allo-HSCT using bone marrow stem cells in adults with haematological malignancies. We found moderate-quality evidence that PBSCT was associated with faster engraftment of neutrophils and platelets, but a higher risk of GvHD (in terms of more overall and extensive chronic GvHD). There was an imprecise effect on relapse and on severe (grades III to IV) acute GvHD. Quality of life, which is severely affected by GvHD, was not evaluated.Against the background of transplantation practices that have clearly changed over the past 10 to 15 years, our aim was to provide current data on the best stem cell source for allo-HSCT, by including the results of recently conducted trials. Our review includes participants recruited up to 2009, a proportion of whom were older, had received reduced-intensity conditioning regimens or had been transplanted with stem cells from unrelated donors. However, only one, large, study included relatively recently treated participants. Nevertheless, our findings are comparable to those of previous meta-analyses suggesting that our results hold true for today's practice.
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Allogeneic peripheral blood stem cell and bone marrow transplantation for hematologic malignancies: meta-analysis of randomized controlled trials
Zhang, Haoran, Chen, Junmin, Que, Wenzhong
Leuk Res. 2012;36(4):431-7
Abstract
Peripheral blood stem cells have emerged as an alternative to bone marrow for allogeneic transplantation. To elucidate the advantages and disadvantages of research evidence related to the effects of allogeneic peripheral blood stem cells transplantation (PBSCT) and bone marrow transplantation (BMT) for hematological malignancies, we conducted a systematic review of the literature of randomized controlled trials comparing PBSCT to BMT. We systematically searched Cochrane Library, MEDLINE, EMBASE and CNKI up to May 2011. Two reviewers independently identified the eligible studies and assessed the methodological quality of included trials. The relevant data were extracted and analysed using RevMan 5.1. Ten trials totaling 1224 patients have been assessed. Pooled comparisons of studies of PBSCT and BMT found that the overall survival in PBSCT group was non-significantly different from that in BMT group [RR 0.92, 95% CI (0.80-1.07)]. The disease-free survival and relapse rate in PBSCT group were significantly different from that in BMT group [RR 0.67, 95% CI (0.52-0.86) and RR 0.51, 95% CI (0.34-0.76), respectively]. The number of days to reach the absolute neutrophil and platelet count were shorter with PBSCT. The rates of acute and chronic graft-versus-host disease (GVHD) in PBSCT group were significantly higher than that in the BMT group. The mortality in PBSCT group was non-significantly different from that in BMT group. We concluded that PBSCT was associated with a similar overall survival and mortality, improved disease-free survival and a decrease in relapse, faster engraftment, more GVHD when compared with BMT in transplantation for hematologic malignancies.Copyright © 2011 Elsevier Ltd. All rights reserved.