Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Nov;101(11):2497-2506.
doi: 10.1007/s00277-022-04965-x. Epub 2022 Aug 30.

Allogeneic hematopoietic stem cell transplantation for pediatric acute myeloid leukemia in first complete remission: a meta-analysis

Riccardo Masetti  1 , Edoardo Muratore  2 , Davide Gori  3 , Arcangelo Prete  1 , Franco Locatelli  4
Affiliations
Meta-Analysis

Allogeneic hematopoietic stem cell transplantation for pediatric acute myeloid leukemia in first complete remission: a meta-analysis

Riccardo Masetti et al. Ann Hematol. 2022 Nov.

Abstract

Identification of pediatric patients with acute myeloid leukemia (AML) candidates to receive allogeneic hematopoietic stem cell transplantation (allo-HSCT) in first complete remission (CR1) is still a matter of debate. Currently, transplantation is reserved to patients considered at high risk of relapse based on cytogenetics, molecular biology, and minimal residual disease (MRD) assessment. However, no randomized clinical trial exists in the literature comparing transplantation with other types of consolidation therapy. Here, we provide an up-to-date meta-analysis of studies comparing allo-HSCT in CR1 with chemotherapy alone as a post-remission treatment in high-risk pediatric AML. The literature search strategy identified 10 cohorts from 9 studies performing as-treated analysis. The quantitative synthesis showed improved overall survival (OS) (relative risk, 1.15; 95% confidence interval [CI], 1.06-1.24; P = 0.0006) and disease-free survival (relative risk, 1.31; 95% CI, 1.17-1.47; P = 0.0001) in the allo-HSCT group, with increased relapse rate in the chemotherapy group (relative risk, 1.26; 95% CI, 1.07-1.49; P = 0.006). Sensitivity analysis including prospective studies alone and excluding studies that reported the comparison only on intermediate-risk patients confirmed the benefit of allo-HSCT on OS. Further research should focus on individualizing allo-HSCT indications based on molecular stratification and MRD monitoring.

Keywords: Acute myeloid leukemia; Allogeneic hematopoietic stem cell transplantation; Pediatrics.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of the search strategy and included studies. The relevant number of papers at each point is given
Fig. 2
Fig. 2
Forest plot showing the association between allo-HSCT and improved OS in higher-risk pediatric AML in CR1. (A) All included studies. (B) Only prospective trials. (C) Excluding studies including only IR patients. HSCT, hematopoietic stem cell transplantation
Fig. 3
Fig. 3
Forest plot showing the association between allo-HSCT and reduced relapse-related outcomes in higher-risk pediatric AML in CR1. (A) RR, (B) DFS. DFS, disease-free survival; HSCT, hematopoietic stem cell transplantation; RR, relapse rate
See this image and copyright information in PMC

References

    1. Pui C-H, Carroll WL, Meshinchi S, Arceci RJ. Biology, risk stratification, and therapy of pediatric acute leukemias: an update. J Clin Oncol. 2011;29:551–565. doi: 10.1200/JCO.2010.30.7405. - DOI - PMC - PubMed
    1. Lonetti A, Indio V, Laginestra MA, Tarantino G, Chiarini F, Astolfi A, et al. Inhibition of methyltransferase dot1l sensitizes to sorafenib treatment aml cells irrespective of mll-rearrangements: a novel therapeutic strategy for pediatric aml. Cancers (Basel) 2020;12:1–18. doi: 10.3390/cancers12071972. - DOI - PMC - PubMed
    1. Zwaan CM, Kolb EA, Reinhardt D, Abrahamsson J, Adachi S, Aplenc R, et al. Collaborative efforts driving progress in pediatric acute myeloid leukemia. J Clin Oncol. 2015;33:2949–2962. doi: 10.1200/JCO.2015.62.8289. - DOI - PMC - PubMed
    1. Creutzig U, Van Den Heuvel-Eibrink MM, Gibson B, Dworzak MN, Adachi S, De Bont E, et al. Diagnosis and management of acute myeloid leukemia in children and adolescents: recommendations from an international expert panel. Blood. 2012;120:3167–3205. doi: 10.1182/blood-2012-03-362608. - DOI - PubMed
    1. Hasle H. A critical review of which children with acute myeloid leukemia need stem cell procedures. Br J Haematol. 2014;166:23–33. doi: 10.1111/bjh.12900. - DOI - PubMed

Publication types