Allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission: systematic review and meta-analysis of prospective clinical trials
Koreth J et al. - In a study to quantify relapse-free survival (RFS) and overall survival (OS) benefit of allogeneic stem cell transplantation (SCT) for acute myeloid leukemia (AML) in first complete remission (CR1) overall and also for good-, intermediate-, and poor-risk AML, it was concluded that compared with nonallogeneic SCT therapies, allogeneic SCT has significant RFS and OS benefit for intermediate- and poor-risk AML, but not for good-risk AML in CR1. Methods- The search used the combined search terms allogeneic; acut* and leukem*/leukaem*/leucem*/leucaem*/aml; myelo* or nonlympho* in the PubMed, Embase, and Cochrane Registry of Controlled Trials databases in March 2009.
- Prospective trials assigning adult pts with AML in CR1 to undergo allogeneic SCT vs nonallogeneic SCT treatment(s) based on donor availability and trials reporting RFS and/or OS outcomes on an intention-to-treat, donor vs no-donor basis were identified.
Results- The search identified 1712 articles.
- 2 reviewers independently extracted study characteristics, interventions, and outcomes.
- 24 trials and 6007 pts were analyzed (5951 pts in RFS analyses and 5606 pts in OS analyses); 3638 pts were analyzed by cytogenetic risk (547, 2499, and 592 with good-, intermediate-, and poor-risk AML, respectively).
- Interstudy heterogeneity was not significant.
- Fixed-effects meta-analysis was performed.
- Compared with nonallogeneic SCT, the HR of relapse or death with allogeneic SCT for AML in CR1 was 0.80.
- Significant RFS benefit of allogeneic SCT was documented for poor-risk and intermediate-risk AML but not for good-risk AML.
- The HR of death with allogeneic SCT for AML in CR1 was 0.90.
- Significant OS benefit with allogeneic SCT was documented for poor-risk and intermediate-risk AML, but not for good-risk AML.
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