Comparison of Allogeneic Stem Cell Transplant and Autologous Stem Cell Transplant in Refractory or Relapsed Peripheral T-Cell Lymphoma: A Systematic Review and Meta-analysis | Stem Cell Transplantation | JAMA Network Open | JAMA Network
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    Original Investigation
    Hematology
    May 27, 2021

    Comparison of Allogeneic Stem Cell Transplant and Autologous Stem Cell Transplant in Refractory or Relapsed Peripheral T-Cell Lymphoma: A Systematic Review and Meta-analysis

    Author Affiliations
    • 1State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, People’s Republic of China
    • 2Shenzhen PKU-HKUST Medical Center, Shenzhen, People’s Republic of China
    • 3Binjiang College of Nanjing University of Information Science & Technology, Jiangsu, People’s Republic of China
    • 4Department of Hematology, The First Affiliated Hospital of Gannan Medical University, Jiangxi, People’s Republic of China
    JAMA Netw Open. 2021;4(5):e219807. doi:10.1001/jamanetworkopen.2021.9807
    Key Points

    Question  Is allogeneic hematopoietic stem cell transplant (HSCT) or autologous HSCT more effective and safer for patients with refractory or relapsed peripheral T-cell lymphoma?

    Findings  In this systematic review and meta-analysis of 30 trials with 1765 patients, for patients undergoing allogeneic HSCT, the 3-year overall survival was 50%, the 3-year progression-free survival was 42%, and the 3-year transplant-related mortality was 32%. For patients undergoing autologous HSCT, the 3-year overall survival was 55%, the 3-year progression-free survival was 41%, and the 3-year transplant-related mortality was 7%.

    Meaning  These findings suggest that allogeneic HSCT may have better effectiveness but be less safe than autologous HSCT for patients with refractory or relapsed peripheral T-cell lymphoma.

    Abstract

    Importance  Hematopoietic stem cell transplant (HSCT) is an advisable option for refractory or relapsed peripheral T-cell lymphoma (R/R-PTCL), but whether allogeneic HSCT or autologous HSCT is more beneficial is unknown.

    Objective  To compare the effectiveness and safety of allogeneic HSCT vs autologous HSCT in patients with R/R-PTCL.

    Data Sources  A systematic search of the PubMed, Embase, the Cochrane Central Register of Controlled Trials, Wanfang, and China National Knowledge Infrastructure databases with the search items refractory or relapsed peripheral T-cell lymphoma, ASCT/autologous stem-cell transplantation, allo-HSCT/allogeneic stem-cell transplantation, therapeutic effect, and treatment was conducted for articles published from January 12, 2001, to October 1, 2020.

    Study Selection  After duplicate and irrelevant publications were discarded, 329 were ineligible according to the inclusion (clinical trials or retrospective studies with >10 samples) and exclusion criteria (articles without overall survival [OS], progression-free survival [PFS], and transplantation-related mortality [TRM]). Thirty trials were included in the meta-analysis. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.

    Data Extraction and Synthesis  Data on study design, individual characteristics, and outcomes were extracted. All statistics were pooled by applying a random-effects model.

    Main Outcomes and Measures  The prespecified main outcomes were OS, PFS, and TRM.

    Results  Of 6548 articles, data extracted from the 30 studies (including 880 patients who underwent allogeneic HSCT and 885 who underwent autologous HSCT) were included in this meta-analysis. In the allogeneic HSCT group, a 3-year OS of 50% (95% CI, 41%-60%) and PFS of 42% (95% CI, 35%-51%), a 5-year OS of 54% (95% CI, 47%-62%) and PFS of 48% (95% CI, 40%-56%), and a 3-year TRM of 32% (95% CI, 27%-37%) were observed. In the autologous HSCT group, a 3-year OS of 55% (95% CI, 48%-64%) and PFS of 41% (95% CI, 33%-51%), a 5-year OS of 53% (95% CI, 44%-64%) and PFS of 40% (95% CI, 24%-58%), and a 3-year TRM of 7% (95% CI, 2%-23%) were observed.

    Conclusions and Relevance  In this systematic review and meta-analysis, OS and PFS were similar in the allogeneic HSCT and autologous HSCT groups; however, allogeneic HSCT was associated with specific survival benefits among patients with R/R-PTCL.

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