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Allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission: systematic review and meta-analysis of prospective clinical trials
JAMA, 06/11/09

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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