Song Yanzhi, Yin Zhichao, Ding Jie, Wu Tong
Bone Marrow Transplantation, Beijing Boren Hospital, Beijing, China.
School of Medicine, Johns Hopkins University, Baltimore, MD, United States.
Front Oncol. 2021 Oct 7;11:708727. doi: 10.3389/fonc.2021.708727. eCollection 2021.
Reduced intensity conditioning (RIC) before allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been reported to have the same overall survival (OS) as myeloablative conditioning (MAC) for patients with acute myeloid leukemia (AML) in complete remission (CR) and myelodysplastic syndrome (MDS). However, results from different studies are conflicting. Therefore, we conducted a systematic review and meta-analysis guided by PRISMA 2009 to confirm the efficacy and safety of RIC vs. MAC for AML in CR and MDS.
We search PubMed, Web of Science, Embase, Cochrane central, clinical trial registries and related websites, major conference proceedings, and field-related journals from January 1, 1980, to July 1, 2020, for studies comparing RIC with MAC before the first allo-HSCT in patients with AML in CR or MDS. Only randomized controlled trials (RCTs) were included. OS was the primary endpoint and generic inverse variance method was used to combine hazard ratio (HR) and 95% CI.
We retrieved 7,770 records. Six RCTs with 1,413 participants (711 in RIC, 702 in MAC) were included. RIC had the same OS (HR = 0.95, 95% CI 0.64-1.4, = 0.80) and cumulative incidence of relapse as MAC (HR = 1.18, 95% CI 0.88-1.59, = 0.28). Furthermore, RIC significantly reduced non-relapse mortality more than total body irradiation/busulfan-based MAC (HR = 0.53, 95% CI 0.36-0.80, = 0.002) and had similar long-term OS and graft failure as MAC.
RIC conditioning regimens are recommended as an adequate option of preparative treatment before allo-HSCT for patients with AML in CR or MDS.
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=185436.
据报道，对于处于完全缓解（CR）期的急性髓系白血病（AML）患者和骨髓增生异常综合征（MDS）患者，异基因造血干细胞移植（allo-HSCT）前采用减低强度预处理（RIC）与采用清髓性预处理（MAC）的总生存期（OS）相同。然而，不同研究的结果相互矛盾。因此，我们按照PRISMA 2009进行了一项系统评价和荟萃分析，以证实RIC与MAC用于CR期AML和MDS的疗效和安全性。
我们检索了1980年1月1日至2020年7月1日期间的PubMed、科学网、Embase、Cochrane中心、临床试验注册库及相关网站、主要会议论文集以及相关领域期刊，以查找比较CR期AML或MDS患者首次allo-HSCT前RIC与MAC的研究。仅纳入随机对照试验（RCT）。OS为主要终点，采用通用逆方差法合并风险比（HR）和95%置信区间（CI）。
我们检索到7770条记录。纳入了6项RCT，共1413名参与者（RIC组711名，MAC组702名）。RIC与MAC的OS相同（HR = 0.95，95% CI 0.64 - 1.4，P = 0.80），复发累积发生率也相同（HR = 1.18，95% CI 0.88 - 1.59，P = 0.28）。此外，与基于全身照射/白消安的MAC相比，RIC显著降低了非复发死亡率（HR = 0.53，95% CI 0.36 - 0.80，P = 0.002），并且与MAC具有相似的长期OS和移植物失败率。
对于CR期AML或MDS患者，推荐将RIC预处理方案作为allo-HSCT前预处理治疗的合适选择。
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=185436
