Similar outcomes after haploidentical transplantation with post-transplant cyclophosphamide versus HLA-matched transplantation: a meta-analysis of case-control studies

// Zhenyang Gu 1, 2, * , Li Wang 1, 3, * , Lei Yuan 1, * , Wenrong Huang 1 , Meng Li 1 , Lixun Guan 1 , Qingyi Wang 4 , Zhe Gao 1 , Shasha Zhao 1 , Lan Luo 1 , Feiyan Wang 1 , Nan Yang 1 , Daihong Liu 1 , Jon C. Aster 2 and Chunji Gao 1 1 Department of Hematology, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China 2 Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA 3 Department of Hematology and Oncology, Laoshan Branch, No. 401 Hospital of Chinese PLA, Qingdao, China 4 Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, MA, USA * These authors have contributed equally to this work Correspondence to: Chunji Gao, email: gaochunji@medmail.com.cn Jon C. Aster, email: jaster@rics.bwh.harvard.edu Keywords: post-transplant cyclophosphamide, haploidentical, hematopoietic cell transplantation, HLA-matched, similar outcomes Received: January 17, 2017     Accepted: June 02, 2017     Published: June 29, 2017 ABSTRACT Background: Outcomes of haploidentical hematopoietic cell transplantation (haplo-HCT) with post-transplant cyclophosphamide (PT-Cy) have greatly improved. It remains unknown whether haplo-HCT with PT-Cy was associated with poor outcomes when compared with HLA-matched HCT. To address this issue, we performed a meta-analysis to compare outcomes of haplo-HCT with PT-Cy with those of HLA-matched HCT. Methods: A systematic search for case-control studies were performed in PubMed, Embase and Cochrane Library databases. Using a random model, the risk ratios (RRs) and 95% confidence intervals (95% CI) were pooled for the final analysis. Results: Nine case-control studies including 2258 patients (827 patients in the haplo-HCT with PT-Cy group, 748 controls from HLA-matched related donors (MRD), and 683 controls from HLA-matched unrelated donors (MUD)) met the inclusion criteria. No differences were found between haplo-HCT with PT-Cy and HLA-matched HCT with regard to acute graft-versus-host-disease (GVHD), non-relapse mortality, relapse, progression free survival and overall survival. However, haplo-HCT with PT-Cy was found to be associated with a lower incidence of moderate to severe chronic GVHD (Haplo vs MRD: RR=0.54; 95% CI=0.39-0.75; Haplo vs MUD: RR=0.70; 95% CI=0.56-0.88). Conclusions: The results of this meta-analysis suggest that haplo-HCT with PT-Cy can achieve comparable outcomes with those of HLA-matched HCT. Haploidentical donors can be a feasible and valid alternative when conventional HLA-matched donors are unavailable.