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Effects of donor-specific antibodies on engraftment and long-term survival after allogeneic hematopoietic stem cell transplantation—A systematic review and meta-analysis

Bone Marrow Transplantation volume 58, pages 544–551 (2023)Cite this article

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Abstract

The presence of donor-specific antibodies (DSAs) have been reported to be associated with an increased risk of primary graft failure following allogeneic hematopoietic stem cell transplantation (allo-HSCT), but its effects on the time to engraftment and long-term outcomes remain unclear. We performed a systematic review and meta-analysis of studies investigating the impact of DSAs on engraftment and long-term survival of patients undergoing allo-HSCT. We systematically searched PubMed, Embase, the Cochrane Library, and CBM. Data were analyzed using RevMan5.4. Pooled hazard ratio (HR), standard mean difference (SMD) or odds ratio (OR) and corresponding 95% confidence interval (CI) are calculated for time-to-event data, continuous data, discontinuous data respectively. 17 eligible studies were included, involving 2169 patients main receiving haploidentical SCT (haplo-SCT) or umbilical cord blood transplantation (UCBT). Meta-analysis showed that DSAs-positive patients are associated with significantly higher risk of GF(OR = 12.87, 95%CI, 6.45–25.70; P < 0.00001; OR = 4.76, 95%CI, 2.88–7.87), poorer neutrophil engraftment (HR = 2.20, 95%CI, 1.02–4.73; P = 0.04; HR = 1.83, 95%CI, 1.46–2.30; P < 0.00001), worse OS (HR = 3.19, 95%CI, 1.85–5.50; P < 0.0001; HR = 1.68, 95%CI, 1.04–2.71; P = 0.03), and inferior PFS (HR = 4.25, 95%CI, 1.59–11.40; P = 0.004; HR = 4.83, 95%CI, 1.65–14.12; P = 0.004) in haplo-SCT and UCBT, respectively.

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Fig. 1: The flow chart of study selection.
Fig. 2: Forest plot with OR and 95% CI for graft failure.
Fig. 3: Forest plot with HR and 95% CI for the cumulative incidence of neutrophil engraftment.
Fig. 4: Forest plot with HR and 95% CI for overall survival.
Fig. 5: Forest plot with HR and 95% CI for progression-free survival.
Fig. 6: Funnel plot.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

Funding

Prof. Xu was supported by the Project from Southwest Hospital (2022DZXDX004). Prof Chen was supported by the Logistics Project (AWS17J007).

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Author notes

  1. These authors contributed equally: Yarui Huang, Chengxin Luo.

Authors and Affiliations

  1. Center for Hematology, Southwest Hospital, Third Military Medical University, Chongqing, China

    Yarui Huang, Chengxin Luo, Guixian Wu, Xiangtao Huang, Yaqun Ding, Zhen Huang, Jieping Chen & Shuangnian Xu

  2. Key Laboratory of Cancer Immunotherapy of Chongqing, Chongqing, China

    Yarui Huang, Chengxin Luo, Guixian Wu, Xiangtao Huang, Yaqun Ding, Zhen Huang, Jieping Chen & Shuangnian Xu

  3. Department of Hematology, Daping Hospital, Third Military Medical University, Chongqing, China

    Xi Li

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Contributions

YRH and SNX designed the project and protocols. YRH and CXL conducted the searches, extracted the data, and excluded duplicates. GXW, XTH, ZH and YQD, screened studies, conducted quality appraisal and extracted data. YRH performed the meta-analysis, accessing the raw data. YRH and CXL drafted the manuscript. JPC, QL and SNX critically revised the manuscript.

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Correspondence to Jieping Chen, Xi Li or Shuangnian Xu.

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Huang, Y., Luo, C., Wu, G. et al. Effects of donor-specific antibodies on engraftment and long-term survival after allogeneic hematopoietic stem cell transplantation—A systematic review and meta-analysis. Bone Marrow Transplant 58, 544–551 (2023). https://doi.org/10.1038/s41409-023-01932-6

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