Maintenance Therapy with Hypomethylating Agents for Patients with Acute Myeloid Leukemia in First Remission Not Eligible for Allogeneic Hematopoietic cell Transplantation: A Systematic Review and Meta-Analysis

Abstract The purpose of this paper is to systematically analyze the outcome of FLT3 inhibitors maintenance treatment following hematopoietic stem cell transplantation (HSCT) for patients suffering from FLT3-ITD-mutated acute myeloid leukemia (AML). Pubmed, Embase, and Cochrane Library databases were retrieved before November 2021. Fifteen studies were included eventually containing six without control and nine with control. Thirteen studies evaluated sorafenib, and two assessed quizartinib and midostaurin, separately. Via survival analysis, the main outcomes in the FLT3 inhibitors group were improved greatly with the hazard ratio(HR) of overall survival of 0.38 (95% confidence interval [CI], 0.29-0.49; P < 0.001), HR of leukemia-free survival of 0.35 (95%CI, 0.27-0.47; P < 0.001) and HR of cumulative incidence of relapse of 0.32 (95%CI, 0.23-0.45; P < 0.001). Moreover, the TKI use didn’t seem to increase the incidence of graft-versus-host disease (GVHD) and adverse effects in statistics. Through subgroup analysis, MRD-positive patients before and after HCT, and MRD-negative patients before HCT might benefit a lot from sorafenib maintenance.

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Maintenance with Hypomethylating Agents after Allogeneic Stem Cell Transplantation in Acute Myeloid Leukemia and Myelodysplastic Syndrome: A Systematic Review and Meta-Analysis

10.37766/inplasy2021.11.0078 ◽

2021 ◽

Author(s):

Smith Kungwankiattichai ◽

◽

Ben Ponvilawa ◽

Claudie Roy ◽

Pattaraporn Tunsing ◽

...

Keyword(s):

Acute Myeloid Leukemia ◽

Stem Cell ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Myeloid Leukemia ◽

Meta Analysis ◽

Hypomethylating Agents ◽

Eligibility Criteria ◽

Hematopoietic Stem ◽

Acute Myeloid

Review question / Objective: P: Patients with AML or MDS after allo-SCT; I: Hypomethylating agents after allo-SCT; C: Observation after allo-SCT; O: Overall survival rates. Condition being studied: Hypomethylating agents (HMAs) seem to have a range of properties favorable to post-allogeneic hematopoietic stem cell transplantation (allo-SCT) maintenance in acute myeloid leukemia (AML) patients. This meta-analysis was performed to review all relevant studies to compare the outcomes of patients undergoing allo-SCT for AML or MDS receiving HMA maintenance therapy with observation only. Information sources: The systematic search of the Embase and MEDLINE databases identified 4,416 articles, from which 512 duplicates were removed. This resulted in 3,904 articles available for title and abstract review. Subsequently, 3,875 articles were excluded as the article type and study design did not fulfill the inclusion criteria, or there was no report on a primary outcome of interest. The remaining 29 articles underwent full-length review and 18 of those were excluded for the aforementioned reasons. Ultimately, the eligibility criteria for our meta-analysis were met by 11 studies: 2 RCTs, 1 prospective cohort study, and 8 retrospective cohort studies.

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