Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Jun 18, 2023; 11(5): 181-195
Published online Jun 18, 2023. doi: 10.13105/wjma.v11.i5.181
Haploidentical hematopoietic stem cell transplantation as promising therapy in the improved survival of pediatric patients with leukemias and myelodysplasias
Ana Clara Carvalho Cardoso Brito, Everton Oliveira Carneiro Ribeiro, Fabrício Freire de Melo
Ana Clara Carvalho Cardoso Brito, Everton Oliveira Carneiro Ribeiro, Fabrício Freire de Melo, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
Author contributions: Cardoso Brito ACC, Oliveira Carneiro Ribeiro E, and Freire de Melo F equally contributed to this paper with the conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version; and all authors agree to be accountable for all aspects of the work in ensuring that questions that are related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fabrício Freire de Melo, PhD, Professor, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, 3293-3391-Candeias, Estrada do Bem Querer, Vitória da Conquista 45029-094, Bahia, Brazil. freiremeloufba@gmail.com
Received: February 10, 2023
Peer-review started: February 10, 2023
First decision: March 28, 2023
Revised: April 21, 2023
Accepted: May 16, 2023
Article in press: May 16, 2023
Published online: June 18, 2023
Processing time: 125 Days and 9.6 Hours
Abstract
BACKGROUND

Haploidentical hematopoietic stem cell transplantation (Haplo-HSCT) is often performed in children with hematologic malignancies. Faced with the gap in the literature regarding the approach to experiences related to Haplo-HSCT with pediatric patients with leukemias and myelodysplasias aged up to 18 years, there was an interest in exploring the clinical outcomes of patients undergoing this treatment.

AIM

To identify and summarize the scientific contributions available on Haplo-HSCT performed in the last 10 years in children and adolescents with myeloid and lymphoid leukemias and myelodysplasias, aged up to 18 years.

METHODS

This is a descriptive systematic review. We extracted data including characteristics of participants, health condition, characteristics of the donation, conditioning regimen, recurrent clinical complications and clinical outcomes. The Virtual Health Library Brazil, PubMed, EMBASE, and SciELO platforms were used, finding a total of 1052 studies. After the eligibility criteria and complete reading of the texts, 18 articles were included for analysis.

RESULTS

The total sample of all study cohorts was 1825 patients, mostly male, the highest reported median age was 15.0 years and the lowest was 1.2 years. Acute graft-versus-host disease and chronic graft-versus-host disease were observed in almost all studies. Relapse, graft rejection and delayed immune recovery were identified as major clinical challenges. Pre-transplant minimal positive residual disease was identified in 288 patients. Infections are also among the main clinical complications, viral, bacterial and fungal infections being reported. It is observed that in the 5-year interval, the lowest rates of EFS and overall survival (OS) were 29.5% and 68.0%, respectively. While, the highest rates of EFS and OS, in the same interval, were 80.1% and 81.0%.

CONCLUSION

Haplo-HSCT represents a promising therapy, considering the potential number of possible donors and the conditioning and treatment platforms that can be offered. The results obtained show that this type of transplant has a strong antileukemic effect, with generally favorable OS rates. Overcoming relapse as the first cause of transplant failure is the great clinical challenge.

Keywords: Haploidentical; Stem cell transplantation; Children; Cancer; Treatment outcome; Prognosis

Core Tip: In recent years, the number of children under 18 years of age with leukemias and myelodysplasias undergoing haploidentical hematopoietic stem cell transplantation has increased. This type of transplant has been shown to be a promising therapy due to the availability of potential donors. The main objective is to identify the scientific contributions available on haploidentical hematopoietic stem cell transplantation performed with this audience. It has been observed that prognostic factors such as treatment platforms, cytogenetic abnormalities and disease status exert a strong influence on the clinical outcomes of transplant patients. Other variables can be obtained to collaborate with risk stratification and donor selection approaches.