Efficacy of bone marrow transplantation in treating acute myeloid leukemia: a systematic review and meta-analysis

Abstract

Objective: To systematically assess the efficacy of hematopoietic stem cell transplantation (HSCT) and bone marrow transplantation (BMT) in treating acute myeloid leukemia (AML).

Methods: PubMed, EMBASE, ScienceDirect, Cochrane Library, China National Knowledge Infrastructure (CNKI), China VIP database, Wanfang database and China Biomedical Literature Database (CBM) were searched for case-control trials of bone marrow HSCT and peripheral HSCT (PHSCT) for treating AML. Two independent researchers extracted the data between January 2000 and May 2022. Each retrieved article was assessed according to the bias risk defined in Cochrane Handbook 5.3, and data were analyzed by meta-analysis using RevMan5.3.

Results: Through computer database retrieval, 7 clinical controlled studies were included, with 1280 samples. A meta-analysis was conducted on the survival rates. The PHSCT and the BMT groups showed no noticeable difference in overall survival (OS) and disease-free survival (DFS) rates (P>0.05). The incidence of acute graft-versus-host disease (GVHD) and chronic GVHD in the BMT group was noticeably lower (P<0.05). The disease recurrence rate in tthe BMT group was lower (P<0.05), but no noticeable differences were found in recurrence-related mortality (P>0.05). Furthermore, there was also no noticeable difference in non-relapse-related mortality (P>0.05). Funnel charts were drawn on the basis of OS rate, DFS rate, incidences of acute GVHD and chronic GVHD, and recurrence. Afterwards publication bias analysis was carried out. Symmetry presented in the majority of the funnel charts and asymmetry was seen in a few, suggesting possible publication bias in the selected literature because of the small sample and the heterogeneity.

Conclusion: BMT can be used as an effective treatment for patients with AML, because it can reduce the recurrence rate and the incidence of complications while ensuring a curative effect, suggesting that BMT is worth popularizing in the clinic. Longer follow-up studies are needed to provide more support for the clinical application of BMT in AML patients.

Keywords: Bone marrow transplantation; curative effect; hematopoietic stem cell transplantation; leukemia.

Figure 1

Illustration of literature screening. *Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers). **If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools. From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/.

Figure 2

Risk bias chart.

Figure 3

Summary chart of risk bias.

Figure 4

Forest analysis of overall survival in patients who received bone marrow transplantation or peripheral hematopoietic stem cell transplantation.

Figure 5

Forest analysis of disease-free survival in patients who received bone marrow transplantation or peripheral hematopoietic stem cell transplantation.

Figure 6

Forest analysis map of incidence of acute graft-versus-host disease in patients who received bone marrow transplantation or peripheral hematopoietic stem cell transplantation.

Figure 7

Forest analysis map of incidence of chronic graft-versus-host disease in patients who received bone marrow transplantation or peripheral hematopoietic stem cell transplantation.

Figure 8

Forest analysis map of recurrence rate in patients who received bone marrow transplantation or peripheral hematopoietic stem cell transplantation.

Figure 9

Forest analysis map of relapse-related mortality in patients that received bone marrow transplantation or peripheral hematopoietic stem cell transplantation.

Figure 10

Forest analysis chart of non-relapse-related mortality in patients that received bone marrow transplantation or peripheral hematopoietic stem cell transplantation.

Figure 11

Funnel chart based on overall survival rate.

Figure 12

Funnel chart based on disease-free survival rate.

Figure 13

Funnel diagram based on incidence of acute graft-versus-host disease.

Figure 14

Funnel diagram based on incidence of chronic graft-versus-host disease.

Figure 15

Funnel chart based on recurrence rate.

Figure 16

Funnel chart based on recurrence-related death.

Figure 17

Funnel chart based on non-recurrence-related death.