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Risk factors for bloodstream infection in paediatric Haematopoietic stem cell transplantation: A systematic review and meta-analysis
Yang, M., Xin, L., Li, H., Lu, X., Pan, X., Lei, S., Li, Y., Zhu, L., Zhu, Q., Jiang, R., et al
The Journal of hospital infection. 2023
Abstract
BACKGROUND Haematopoietic stem cell transplantation (HSCT), a standard treatment for paediatric haematological diseases, is highly associated with bloodstream infections (BSIs), which may increase mortality. AIM: This study aimed to explore the risk factors for BSI in paediatric HSCT recipients. METHODS We searched three English databases and four Chinese databases from inception to March 17, 2022. Eligible studies included randomized controlled trials, cohort studies, and case-control studies that enrolled HSCT recipients aged ≤ 18 years and reported BSI risk factors. Two reviewers independently screened studies, extracted data, and assessed the risk of bias. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) we assessed certainty of body of evidence. FINDINGS Fourteen studies involving 4602 persons were included. The incidences of BSI and associated mortality in paediatric HSCT recipients were approximately 10%-50% and 5%-15%, respectively. Meta-analysis of all studies revealed that previous BSI before HSCT (relative effect [RE] 2.28, 95% confidence interval [CI] 1.19-4.34, moderate certainty) and receiving an umbilical cord blood transplant (RE 1.55, 95% CI 1.22-1.97, moderate certainty) were probably associated with an increased risk of BSI. Meta-analysis of studies with low risk of bias reassured that previous BSI before HSCT probably increased the risk of BSI (RE 2.28, 95% CI 1.19-4.34, moderate certainty), and revealed that steroid use (RE 2.72, 95% CI 1.31-5.64, moderate certainty) was likely a risk factor while autologous HSCT was probably a protective factor of BSI (RE 0.65, 95% CI 0.45-0.94, moderate certainty).
2.
Occurrence and influencing factors of cyclosporine A on the kidney injury following allogeneic hematopoietic stem cell transplantation: A systematic review and meta-analysis
Lu, R., Shi, Y., Yang, M., Yang, N., He, S., Xin, L., Qin, Y., Li, H., Zeng, L., Zou, K., et al
International immunopharmacology. 2023;122:110633
Abstract
OBJECTIVE Whether cyclosporine A (CsA) is a risk factor of kidney injury after allogeneic hematopoietic stem cell transplantation (allo-HSCT) has not been determined. We aim to comprehensively review the correlation and influencing factors between CsA and kidney injury in patients following allo-HSCT. METHODS We searched PubMed, Embase (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL), CNKI, VIP, Wanfang and CBM Database from inception to March 2022. Two researchers independently conducted literature screening, data extraction and quality assessment. Qualitative and quantitative methods were combined to analyze the data. RESULTS We included a total of 30 studies. Meta-analyses of total incidence of kidney injury related to CsA was 37.0% [95% CI (25.4%, 48.6%); n = 15]. The proportion of CsA-related acute kidney injury to total acute kidney injury following allo-HSCT was 59.7% [95% CI (49.1%, 70.3%); n = 9]. One study found that AKI had a significant association with CsA in multivariate analysis [RR = 6.173; 95% CI (4.032, 9.434)]. With respect to cyclosporine combination and nephrotoxicity, 6/9 studies demonstrated that the concomitant medications for CsA (especially aminoglycoside antibiotics and amphotericin B) had negative effect on kidney functions related to CsA in allo-HSCT patients. No consensus was reached for "dose of CsA", "duration of CsA use", "comorbidities" and "CsA levels" across studies. CONCLUSIONS CsA may be a risk factor for kidney injury in patients following allo-HSCT, especially the concomitant use of CsA and nephrotoxic medications.
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Haploidentical versus matched donor stem cell transplantation for patients with hematological malignancies: a systemic review and meta-analysis
Yang, B., Yu, R., Cai, L., Bin, Guo, Chen, H., Zhang, H., He, P., Lu, X.
Bone marrow transplantation. 2018
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Editor's Choice
Abstract
We compared the safety and efficacy of haploidentical stem cell transplantation (haplo-SCT) to matched donor SCT (matched-SCT) in treating hematological malignancies. The Medline, Cochrane, EMBASE, and Google Scholar databases were searched through 21 June 2017 using the search term "(hematological disease) AND matched AND (haploidentical OR haplo-identical OR haplo identical OR haplo transplantation OR haplo transplant OR haplo-SCT OR haplo-HSCT OR haplo-HCT)." Twenty-five studies enrolling 11,359 patients (haplo-SCT: 2677; matched-SCT: 8682) were included. The primary outcomes were acute and chronic graft-versus-host disease (GVHD), non-relapse mortality, and 1-year cumulative incidence of relapse. Haplo-SCT was associated with similar risks as matched-SCT for all primary endpoints. Subgroup analysis of patients who received a matched-SCT from a related donor revealed that patients who received haplo-SCT had a lower risk of acute GVHD. Among patients who received reduced-intensity conditioning (RIC), those who received haplo-SCT had a higher risk of acute grade II-IV GVHD and non-relapse mortality than did patients who received a matched-SCT from a related or unrelated donor. Haplo-SCT should continue to be considered as a safe and effective transplant option when a matched donor is unavailable, but it may not be suitable for patients who receive RIC.