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Meta-Analysis
. 2013 Jan 10;121(2):339-50.
doi: 10.1182/blood-2012-07-445098. Epub 2012 Nov 19.

Allogeneic, but not autologous, hematopoietic cell transplantation improves survival only among younger adults with acute lymphoblastic leukemia in first remission: an individual patient data meta-analysis

Collaborators, Affiliations
Meta-Analysis

Allogeneic, but not autologous, hematopoietic cell transplantation improves survival only among younger adults with acute lymphoblastic leukemia in first remission: an individual patient data meta-analysis

Vikas Gupta et al. Blood. .

Abstract

Hematopoietic cell transplantation (HCT) and prolonged chemotherapy are standard postremission strategies for adult acute lymphoblastic leukemia in first complete remission, but the optimal strategy remains controversial. There are no randomized trials of allogeneic HCT. In the present study, updated individual patient data were collected and analyzed from studies with information on availability of matched sibling donor (used to mimic randomization) and from randomized trials of autograft versus chemotherapy. Data from 13 studies including 2962 patients, excluding Philadelphia chromosome-positive patients, showed a survival benefit for having a matched sibling donor for patients < 35 years of age (OR = 0.79; 95% CI, 0.70-0.90, P = .0003) but not for those ≥ 35 years of age (OR = 1.01; 95% CI, 0.85-1.19, P = .9; heterogeneity P = .03) because of the higher absolute risk of nonrelapse mortality for older patients. No differences were seen by risk group. There was a trend toward inferior survival for autograft versus chemotherapy (OR = 1.18; 95% CI, 0.99-1.41; P = .06). No beneficial effect of autografting was seen compared with chemotherapy in this analysis. We conclude that matched sibling donor myeloablative HCT improves survival only for younger patients, with an absolute benefit of approximately 10% at 5 years. Improved chemotherapy outcomes and reduced nonrelapse mortality associated with allogeneic HCT may change the relative effects of these treatments in the future.

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Figures

Figure 1
Figure 1
Effect of autograft versus chemotherapy on overall survival in each trial.
Figure 2
Figure 2
Descriptive curve of overall survival by autograft versus chemotherapy.
Figure 3
Figure 3
Effect of donor versus no donor on time to relapse in each trial. Ph+ patients were excluded.
Figure 4
Figure 4
Effect of donor versus no donor on TRM in each trial. Ph+ patients were excluded.
Figure 5
Figure 5
Effect of donor versus no donor on overall mortality in each trial. Ph+ patients were excluded.
Figure 6
Figure 6
Descriptive curve of overall survival by donor versus no donor. Ph+ patients were excluded.
Figure 7
Figure 7
Effect of donor versus no donor on overall mortality in subgroups. Ph+ patients were excluded.

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References

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