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

Frontiers in Medicine

article

Smith Kungwankiattichai¹  Ben Ponvilawan²  Claudie Roy³  Pattaraporn Tunsing¹  Florian Kuchenbauer³  Weerapat Owattanapanich¹ 

[1] Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University;Department of Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University;Vancouver General Hospital, L/BMT Program of British Columbia;British Columbia Research Centre, Terry Fox Laboratory

关键词: acute myeloid leukemia;    azacitidine;    decitabine;    hypomethylating agent;    maintenance;    transplant;   

DOI  :  10.3389/fmed.2022.801632

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

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.

【 授权许可】

CC BY