Published online Jun 18, 2023. doi: 10.13105/wjma.v11.i5.181
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
Haploidentical hematopoietic stem cell transplantation (Haplo-HSCT) has been performed in patients with different hematological malignancies. This type of transplant is performed with a related donor with partially HLA matching; therefore, it has a high availability. In recent years, the number of children with leukemia and myelodysplasia submitted to Haplo-HSCT has increased. However, there are few evaluations on the efficacy and safety of this treatment, considering only the pediatric public under 18 years of age.
The availability of donors in the Haplo-HSCT has been listed as one of the main reasons for carrying it out with the pediatric public, arousing the interest of researchers in evaluating the benefits of this treatment. In this sense, we sought to assess the factors that influence the prognosis of patients, complications and clinical outcomes.
To identify and summarize the scientific contributions available on haploidentical hematopoietic stem cell transplants performed in the last 10 years in children and adolescents with myeloid and lymphoid leukemias and myelodysplasias, aged up to 18 years.
This is a descriptive systematic review. The VHL, PubMed, EMBASE and SciELO databases were consulted, but the results were only obtained in the first three. Based on the eligibility criteria, 18 articles were included in this review. For data extraction, the characteristics of the patients and treatment were sought, which included the number of patients, age group, gender, health condition, characteristics of the donation, conditioning regimen and recurrent clinical complications.
The studies included 1825 patients, most of whom were men, although gender was not an independent factor for the patients’ prognosis. Regarding age, the data are inconclusive, as well as for the source of stem cells. Pre-transplant DRM status and intense immunosuppressive therapy are also factors that impact patient prognosis. The main complications observed were acute graft-versus-host disease, chronic graft-versus-host disease and infections. Clinical challenges are relapse, graft rejection and delayed immune recovery. In general, the studies indicated good results for patients treated in first complete remission and with early referral.
The indication of Haplo-HSCT for patients in first complete remission is evident. Studies have shown efficient results for patients treated in this phase and with early referral, with significantly important and differentiated survival. In this perspective, considering the potential number of potential donors and the treatment platforms that can be offered, Haplo-HSCT appears to be a promising therapy. Randomized clinical trials and meta-analyses should be performed to confirm the reported findings.
The pre-MRD+ was pointed out as a poor prognostic factor, as well as age and cell source, but the numbers were too few for a complete analysis. Thus, it is suggested that researchers consider these aspects and include the MRD status, with pre-MRD+/pre-MRD- and post-MRD+/post-MRD- cohorts. The analysis of the influence of the ethnicity of the patients must be done, this will contribute even more to the evaluation of the Haplo-HSCT.