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Meta-Analysis
. 2019;141(3):164-175.
doi: 10.1159/000495206. Epub 2019 Feb 26.

Autologous Stem Cell Transplantation Is a Viable Postremission Therapy for Intermediate-Risk Acute Myeloid Leukemia in First Complete Remission in the Absence of a Matched Identical Sibling: A Meta-Analysis

Zhichao Li  1 , Yinmei Liu  2 , Qing Wang  1 , Linjun Chen  1 , Liyuan Ma  1 , Siguo Hao  3
Affiliations
Meta-Analysis

Autologous Stem Cell Transplantation Is a Viable Postremission Therapy for Intermediate-Risk Acute Myeloid Leukemia in First Complete Remission in the Absence of a Matched Identical Sibling: A Meta-Analysis

Zhichao Li et al. Acta Haematol. 2019.

Abstract

Background: The preferred type of postremission therapy (PRT) for intermediate-risk acute myeloid leukemia (AML) in first complete remission (CR1) is a subject of continued debate. Although allogeneic stem cell transplantation (alloSCT) is regarded as a curative strategy for AML, the efficacy of autologous stem cell transplantation (autoSCT) for patients without a matched sibling donor (MSD) has remained controversial.

Methods: To compare survival outcomes after alloSCT versus autoSCT for patients with intermediate-risk AML in CR1, we performed a meta-analysis of 11 clinical studies. The outcomes included relapse-free survival (RFS), overall survival (OS), relapse rate (RR), and treatment-related mortality (TRM).

Results: Compared with autoSCT, alloSCT showed better RFS, OS, and RR benefits, but higher TRM. Subgroup analysis based on donor category (MSD and matched unrelated donor [MUD]) of alloSCT showed alloSCT from MSD rather than from MUD had better OS benefits compared to autoSCT. For fms-like tyrosine kinase 3 internal tandem duplications (FLT3-ITD) wild-type patients, alloSCT and autoSCT had comparable RFS and OS outcomes.

Conclusion: Our results suggest that, in the absence of an available MSD, autoSCT remains a viable PRT alternative for intermediate-risk AML in CR1, especially for FLT3-ITD wild-type patients.

Keywords: Acute myeloid leukemia; Allogeneic; Autologous; Intermediate risk; Meta-analysis; Transplantation.

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Figures

Fig. 1
Fig. 1
Flow diagram of the studies in meta-analysis.
Fig. 2
Fig. 2
Forest plot of the RFS benefit of alloSCT in intermediate-risk AML/CR1. a Forest plot of the overall RFS benefit and the subgroup RFS benefit based on FLT3-ITD status. b Forest plot of the subgroup RFS benefit based on donor category of alloSCT.
Fig. 3
Fig. 3
Forest plot of the OS benefit of alloSCT in intermediate-risk AML/CR1. a Forest plot of the overall OS benefit and the subgroup OS benefit based on FLT3-ITD status. b Forest plot of the subgroup OS benefit based on donor category of alloSCT.
Fig. 4
Fig. 4
Forest plot of the RR benefit of alloSCT in intermediate-risk AML/CR1.
Fig. 5
Fig. 5
Forest plot of the TRM benefit of alloSCT in intermediate-risk AML/CR1.
Fig. 6
Fig. 6
Funnel plot for publication bias test. a Relapse-free survival. b Overall survival.
See this image and copyright information in PMC

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