Rashidi Armin, Meybodi Mohamad A, Cao Wenhao, Chu Haitao, Warlick Erica D, Devine Steven, Pasquini Marcelo C, Weisdorf Daniel J, Hamadani Mehdi
Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
Biol Blood Marrow Transplant. 2020 Jun;26(6):e138-e141. doi: 10.1016/j.bbmt.2020.03.003. Epub 2020 Mar 12.
In a systematic review and meta-analysis, we compared allogeneic transplant outcomes after myeloablative conditioning (MAC) versus reduced-intensity conditioning (RIC) in patients with myelodysplastic syndromes. Only 2 published randomized clinical trials were found, with a pooled sample size of 183 (RIC, 92; MAC, 91). Both studies suggested an overall survival advantage after RIC, with a pooled hazard ratio (HR) of .67 (95% confidence interval [CI], .41 to 1.09) for RIC versus MAC. Relapse results were also concordant, with a pooled HR of 1.55 (95% CI, .74 to 3.25) for RIC versus MAC. Neither result was statistically significant. Comparisons for other outcomes were unremarkable. In conclusion, the evidence for the optimal conditioning intensity in myelodysplastic syndromes is weak. Post-transplant maintenance strategies and incorporation of genomic information into decision-making may improve post-transplant outcomes.
在一项系统评价和荟萃分析中，我们比较了骨髓增生异常综合征患者接受清髓性预处理（MAC）与减低强度预处理（RIC）后的异基因移植结局。仅发现2项已发表的随机临床试验，汇总样本量为183例（RIC组92例；MAC组91例）。两项研究均提示RIC后总生存具有优势，RIC与MAC相比，汇总风险比（HR）为0.67（95%置信区间[CI]，0.41至1.09）。复发结果也一致，RIC与MAC相比，汇总HR为1.55（95%CI，0.74至3.25）。两项结果均无统计学意义。其他结局的比较无明显差异。总之，关于骨髓增生异常综合征最佳预处理强度的证据不足。移植后维持策略以及将基因组信息纳入决策制定可能会改善移植后结局。
