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. 2022 Feb 15:9:801632.
doi: 10.3389/fmed.2022.801632. eCollection 2022.

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

Smith Kungwankiattichai  1 , Ben Ponvilawan  2 , Claudie Roy  3 , Pattaraporn Tunsing  1 , Florian Kuchenbauer  3   4 , Weerapat Owattanapanich  1
Affiliations

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

Smith Kungwankiattichai et al. Front Med (Lausanne). .

Abstract

Introduction: 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.

Materials and methods: The Embase, MEDLINE, and Cochrane Central Register of Controlled Trials databases were independently searched by two investigators to identify relevant studies published inception to 18 November 2021. These trials compared HMA maintenance to observation following allo-SCT for AML or myelodysplastic syndrome.

Results: The meta-analysis eligibility criteria were fulfilled by 14 studies. The overall survival and relapse-free survival of the HMA maintenance group were superior to the observation group, with a pooled risk ratio (RR) of 1.38 and 1.46, respectively. Moreover, the cumulative incidence of relapse was significantly lower in those who received HMAs. The HMA group also had lower non-relapse mortality compared with the observation group. Overall, the incidences of grades III-IV acute graft-vs.-host disease (GVHD) and chronic GVHD did not differ in both groups. However, when looking specifically at those receiving decitabine maintenance, the rate of chronic GVHD seemed to be lower compared with observation alone.

Conclusions: The current systematic review and meta-analysis illustrated that AML and MDS patients receiving HMA maintenance after allo-SCT had better outcomes in regards to OS, RFS, NRM, CIR as well as a reduced incidence of chronic GVHD.

Keywords: acute myeloid leukemia; azacitidine; decitabine; hypomethylating agent; maintenance; transplant.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study identification and literature review process.
Figure 2
Figure 2
Forest plots of the meta-analysis of HMA maintenance compared with no HMA maintenance. (A) OS rate. (B) RFS rate.
Figure 3
Figure 3
Forest plots of the meta-analysis of HMA maintenance compared with no HMA maintenance. (A) NRM rate. (B) CIR rate.
Figure 4
Figure 4
Forest plots of the meta-analysis of HMA maintenance compared with no HMA maintenance. (A) grade III–IV aGVHD rate. (B) cGVHD rate.
Figure 5
Figure 5
Funnel plots of the meta-analysis of HMA maintenance compared with no HMA maintenance. (A) OS rate. (B) RFS rate. (C) NRM rate. (D) CIR rate. (E) grade III–IV aGVHD rate. (F) cGVHD rate.
Figure 6
Figure 6
Subgroup analysis of studies with patients receiving HMA maintenance with DLI and without DLI (A) OS rate (B) RFS rate.
See this image and copyright information in PMC

Comment in

References

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