Comparison of Graft-Versus-Host-Disease after the Bone Marrow Transplantation Versus Peripheral Blood As the Stem Cell Source for HLA Identical Sibling Transplants in Severe Aplastic Anemia: A Systematic Review and Meta-Analysis

Introduction

Severe aplastic anemia (SAA) is a life-threatening disorder and may be associated with significant morbidity and mortality. The first treatment option is allogeneic hematopoietic stem cell transplant (allo-HSCT) for fit patients who have human leukocyte antigen (HLA) identical siblings. Bone marrow is recommended as stem cell source due to less graft versus host disease (GvHD) risk but recently peripheral blood stem cell (PBCS) transplantation has been performed in more centers.

Objective

There are a few study comparing the BM and PBSC source for SAA in the literature. We sought to assess the rates of acute GvHD (aGvHD) and chronic GvHD (cGvHD) to determine the safety of PBSC for transplantation of severe aplastic anemia.

Methods

Comprehensive literature search was conducted on PubMed, Cochrane, and Web of Science using MeSH terms and keywords for " Aplastic Anemia" AND " Stem Cell Transplantation" in July 2022 by following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We applied the time constrain between 2000-2022. Our search produced a total of 2106 records After screening and removing irrelevant and review articles, we included 4 original articles comparing transplantation with PBSC and BM sources and contained results of aGVHD grade 2-4; aGvHD grade 3-4 and cGVHD. Statistical analyses were performed with Comprehensive meta-analysis version 3. Heterogeneity was assessed using the I-squared measure.

Results

A total of 4 studies (5633 patients; 1438 and 4195 patients PBSC and BM respectively) were included in the analysis. All patients were underwent Allo-HSCT with HLA identical siblings. Age of the population, conditioning regimens and GvHD prophylaxis are summarized in the table. The rates of Grade 2-4 aGvHD (OR 1.7 ; 95% CI 1.43-2.02 p<0.001,I²: %24 ), Grade 3-4 aGvHD (OR 1.87 ; 95% CI 1.45-2.42 p<0.001, I²: %0) and cGvHD (OR 2.35 ; 95% CI 2.01-2.74 p<0.001, I²: %73.5) were significantly lower in patients who underwent Allo-HSCT with BM.

Conclusions

The current systematic review and meta-analysis demonstrated that SAA patients who underwent AHSCT with BM had better outcomes in regards to aGvHD as well as reduced incidence of chronic GVHD. Further larger randomized studies are needed to better delineate the role of PBSC in SAA.

No relevant conflicts of interest to declare.