scholarly journals Reduced Intensity Conditioning Followed by Allogeneic Hematopoietic Stem Cell Transplantation Is a Good Choice for Acute Myeloid Leukemia and Myelodysplastic Syndrome: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 11 ◽  
Author(s):  
Yanzhi Song ◽  
Zhichao Yin ◽  
Jie Ding ◽  
Tong Wu
Keyword(s):  
Systematic Review ◽  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Reduced Intensity Conditioning ◽  
Hematopoietic Stem ◽  
Randomized Controlled ◽  
Reduced Intensity ◽  
Acute Myeloid

BackgroundReduced intensity conditioning (RIC) before allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been reported to have the same overall survival (OS) as myeloablative conditioning (MAC) for patients with acute myeloid leukemia (AML) in complete remission (CR) and myelodysplastic syndrome (MDS). However, results from different studies are conflicting. Therefore, we conducted a systematic review and meta-analysis guided by PRISMA 2009 to confirm the efficacy and safety of RIC vs. MAC for AML in CR and MDS.MethodsWe search PubMed, Web of Science, Embase, Cochrane central, clinical trial registries and related websites, major conference proceedings, and field-related journals from January 1, 1980, to July 1, 2020, for studies comparing RIC with MAC before the first allo-HSCT in patients with AML in CR or MDS. Only randomized controlled trials (RCTs) were included. OS was the primary endpoint and generic inverse variance method was used to combine hazard ratio (HR) and 95% CI.ResultsWe retrieved 7,770 records. Six RCTs with 1,413 participants (711 in RIC, 702 in MAC) were included. RIC had the same OS (HR = 0.95, 95% CI 0.64–1.4, p = 0.80) and cumulative incidence of relapse as MAC (HR = 1.18, 95% CI 0.88–1.59, p = 0.28). Furthermore, RIC significantly reduced non-relapse mortality more than total body irradiation/busulfan-based MAC (HR = 0.53, 95% CI 0.36–0.80, p = 0.002) and had similar long-term OS and graft failure as MAC.ConclusionRIC conditioning regimens are recommended as an adequate option of preparative treatment before allo-HSCT for patients with AML in CR or MDS.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=185436.

The Role of Anti-CD33 for the Treatment of Acute Myeloid Leukemia – Systematic Review and Meta-Analysis

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1521-1521
Author(s):  
Ronit Gurion ◽  
Anat Gafter-Gvili ◽  
Ron Ram ◽  
Liat Vidal ◽  
Pia Raanani ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Myeloid Leukemia ◽  
Relapse Rate ◽  
Myeloid Leukemia ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
All Cause Mortality ◽  
Acute Myeloid

Abstract Abstract 1521 The treatment for acute myeloid leukemia (AML) has not changed dramatically for the last 20 years. Anti-CD33 monoclonal antibody therapy, the most prominent of which is gemtuzumab ozogamicin (GO), has been used over the last decade, in order to improve the results of patients with AML. It has been studied in a variety of contexts; at induction, consolidation and as re-induction after disease relapse. Several randomized controlled trials have evaluated the addition of anti-CD33 to chemotherapy as compared to chemotherapy alone for the treatment of AML. Systematic review and meta-analysis of randomized controlled trials comparing addition of anti-CD33 to chemotherapy with chemotherapy alone in patients with AML, for either induction or post-remission therapy. Patients under 18 years old or those with acute promyelocytic leukemia were excluded. The Cochrane Library, MEDLINE, conference proceedings and references were searched until July 2012. Two reviewers appraised the quality of trials and extracted data. Outcomes assessed were: all-cause mortality at 30 days, all-cause mortality at the end of follow up, complete response and relapse rate. Relative risks (RR) were estimated and pooled. Our search yielded 11 included trials, five of them published as abstracts, including 5239 patients. Most trials assessed GO and two trials assessed lintuzumab as the anti-CD33 agent. Dose and schedule differed between trials. Eight trials examined the effect of anti-CD33 in the induction setting: six assessed the addition of anti-CD33 to intensive induction (daunorubicin and cytarabine based) and two used low dose cytarabine in elderly patients. Three trials examined the addition of anti-CD33 in the post remission setting (one as consolidation, one as maintenance and one after relapse). When analyzing the addition of anti-CD33 in all settings together, there was no difference in all-cause mortality at 30 days or at the end of follow up between chemotherapy with anti-CD33 and chemotherapy alone (RR 1.15 [95% CI, 0.96–1.37, 7 trials], RR 0.96 [95% CI, 0.92–1.00, 8 trials] respectively). In the subgroup of favorable and intermediate risk AML, the addition of anti-CD33 had no effect on all-cause mortality, RR 0.94 (95% CI, 0.87–1.02, 3 trials)], however when analyzing the subgroup of favorable risk patients only, mortality was significantly reduced with the use of anti-CD33 (RR 0.60, 95% CI, 0.42–0.85, 2 trials). Treatment with anti-CD33 had no effect on complete remission rate, RR 1.05 (95% CI 0.96–1.14, 7 trials). Yet, it significantly reduced relapse rate, RR 0.90 (95% CI 0.84–0.96, 4 trials). There was not enough data to evaluate the incidence of veno-occlusive disease. In conclusion, the addition of anti-CD33 to chemotherapy significantly decreased relapse rate, with no effect on all cause mortality. Yet, in the favorable risk subgroup, the use of anti-CD33 significantly reduced mortality. Further research is needed to confirm the beneficial effect in the favorable risk AML patients. Disclosures: No relevant conflicts of interest to declare.

Reduced Intensity Conditioning Before Allogeneic Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia in Complete Remission and Myelodysplastic Syndrome: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Yanzhi Song ◽  
Zhichao Yin ◽  
Jie Ding ◽  
Tong Wu
Keyword(s):  
Acute Myeloid Leukemia ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Complete Remission ◽  
Myeloid Leukemia ◽  
Meta Analysis ◽  
Reduced Intensity Conditioning ◽  
Hematopoietic Stem ◽  
Reduced Intensity ◽  
Acute Myeloid

Abstract BackgroundReduced intensity conditioning (RIC) before allogeneic hematopoietic stem cell transplantation (allo-HSCT) was reported had the same overall survival (OS) as myeloablative conditioning (MAC) for acute myeloid leukemia (AML) in complete remission (CR) and myelodysplastic syndrome (MDS) but results in different studies are contradictory. Therefore, we conducted a meta-analysis according to the PRISMA 2009 guidelines to confirm the efficacy and safety of RIC vs. MAC for AML in CR and for MDS.MethodsPubMed, Web of Science, Embase, Cochrane central, related websites, major conference proceedings were searched, and related journals were hand-searched from Jan 1, 1980 to July 1, 2020 for studies comparing RIC with MAC before the first allo-HSCT in patients with AML in CR or MDS. Only RCTs were included. OS was the primary endpoint and generic inverse variance method was used to combine hazard ratio (HR) and 95% CI.ResultsWe retrieved 7770 records. Six RCTs with 1413 participants (711 in RIC, 702 in MAC) were included. RIC had the same OS (HR = 0·95, 95% CI 0·64–1·4, P = 0·80) and cumulative incidence of relapse as MAC (HR = 1·18, 95% CI 0·88–1·59, P = 0·28). RIC reduced non-relapse mortality more than total body irradiation/busulfan based MAC (HR = 0·53, 95% CI 0·36–0·80, P = 0·002).ConclusionRIC also had similar long-term OS and graft failure as MAC. RIC is also a good choice for patients with AML in CR or MDS.

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