Impact of the source of hematopoietic stem cells on immune reconstitution after transplantation: A systematic review.
Level 1 - systematic review of randomized trials
Systematic review of randomized and comparative clinical trials evaluated with Cochrane RoB 2.0.
PubMed 36950969 · doi:10.1111/ejh.13966
What was done
A systematic review was conducted across five electronic databases to evaluate immune reconstitution kinetics across three hematopoietic stem cell (HSC) sources: umbilical cord blood (UCB), bone marrow (BM), and peripheral blood (PB). Included studies were clinical trials and randomized controlled trials comparing at least two HSC sources on natural killer (NK) cell, B-lymphocyte, T-lymphocyte, or neutrophil recovery. Study quality was evaluated using Cochrane RoB 2.0.
What was found
Fourteen studies comprising 2539 subjects were included. Peripheral blood produced the fastest time to neutrophil recovery, umbilical cord blood yielded the highest post-transplant B-cell counts, and bone marrow yielded the lowest T-cell counts. NK-cell counts did not differ significantly between the three graft types. No single HSC source demonstrated overall superiority across all reconstitution parameters. Specific numerical values, recovery times, and effect sizes were not reported in the abstract.
Why it matters
Clinicians choosing between cord blood, bone marrow, and peripheral blood grafts face distinct lineage-specific immune recovery kinetics rather than an all-around superior source.
Limits
The abstract reports only directional findings with no quantitative cell counts, time-to-recovery numbers, or confidence intervals. Confounding variables such as patient age, underlying hematologic malignancies, conditioning regimens, and graft-versus-host disease prophylaxis regimens were not characterized in the abstract.