Comprehensive up-to-date analysis on TCRαβ/CD19-depleted hematopoietic stem cell transplantation in pediatric hematological malignancies

IF 1.6 4区医学 Q4 IMMUNOLOGY

Transplant immunology Pub Date : 2025-03-17 DOI:10.1016/j.trim.2025.102220

Hussien Ahmed H. Abdelgawad , Heba Aboeldahab , Mohamed Mohamed Belal , Mohamed Nabih Bashir , Holly K. Miller , Rupert Handgretinger , Mario Otto

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Abstract

This meta-analysis assesses the efficacy of TCRαβ+/CD19+ depleted hematopoietic stem cell transplantation (HSCT) in pediatric patients with hematological malignancies, bridging the gap in the heterogeneous results of published studies. We analyzed post-HSCT complications and survival outcomes in 1068 children across 14 studies, using both aggregated and patient-level data from acute myeloid leukemia/myelodysplastic syndromes (AML/MDS) and acute lymphoblastic leukemia (ALL) studies, employing the IPDfromKM technique for time-to-event data reconstruction. The analysis reveals a 95 % engraftment success rate (95 % CI: 93–97) and 6-year overall survival and disease-free survival (DFS) rates of 67.2 % and 66.3 %, respectively, with no significant differences in DFS between haploidentical and unrelated donors (hazard ratio = 0.9, 95 % CI: 0.53–1.55). Acute graft-versus-host disease (GvHD) grades III-IV and chronic GvHD incidences were 8 % (95 % CI: 6–11) and 17 % (95 % CI: 10–27). The relapse rate was 27 % (95 % CI: 21–33), with relapse-related mortality at 21 % (95 % CI: 15–28) and HSCT-related mortality at 12 % (95 % CI: 7–19). Relapse was significantly lower in patients (mostly ALL) receiving total body irradiation (risk ratio = 0.53, P = 0.04). These findings underscore TCRαβ/CD19-depleted HSCT as a valuable option for patients without HLA-matched donors, highlighting the need for larger, multicenter studies.

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TCRαβ/ cd19缺失造血干细胞移植治疗儿童恶性血液病的最新综合分析

本荟萃分析评估了TCRαβ+/CD19+缺失造血干细胞移植（HSCT）在儿科血液病恶性患者中的疗效，弥补了已发表研究结果不一致的差距。我们分析了14项研究中1068名儿童的hsct后并发症和生存结果，使用急性髓性白血病/骨髓增生异常综合征（AML/MDS）和急性淋巴细胞白血病（ALL）研究的汇总数据和患者水平数据，采用IPDfromKM技术进行事件时间数据重建。分析显示，移植成功率为95 %(95 % CI: 93-97)， 6年总生存率和无病生存率（DFS）分别为67.2 %和66.3% %，单倍相同供体和非相关供体的DFS无显著差异（风险比 = 0.9,95 % CI: 0.53-1.55）。急性移植物抗宿主病（GvHD） III-IV级和慢性GvHD发生率分别为8 %（95 % CI: 6-11）和17 %（95 % CI: 10-27）。复发率为27 %(95 % CI: 21-33)，复发相关死亡率为21 %(95 % CI: 15-28)， hsct相关死亡率为12 %（95 % CI: 7-19）。接受全身照射的患者（多为ALL）复发率明显降低（风险比 = 0.53,P = 0.04）。这些发现强调了TCRαβ/ cd19缺失的HSCT对于没有hla匹配供体的患者是一个有价值的选择，强调了更大规模、多中心研究的必要性。

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来源期刊

Transplant immunology 医学-免疫学

CiteScore

2.10

自引率

13.30%

发文量

198

审稿时长

48 days

期刊介绍： Transplant Immunology will publish up-to-date information on all aspects of the broad field it encompasses. The journal will be directed at (basic) scientists, tissue typers, transplant physicians and surgeons, and research and data on all immunological aspects of organ-, tissue- and (haematopoietic) stem cell transplantation are of potential interest to the readers of Transplant Immunology. Original papers, Review articles and Hypotheses will be considered for publication and submitted manuscripts will be rapidly peer-reviewed and published. They will be judged on the basis of scientific merit, originality, timeliness and quality.