Allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission: systematic review and meta-analysis of prospective clinical trials: trial

Allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission: systematic review and meta-analysis of prospective clinical trials

Phase meta-analysisN = 6,007

Population

Adults with AML in first complete remission (5951 patients in relapse-free survival analyses and 5606 in overall survival analyses; 3638 analysed by cytogenetic risk: 547 good, 2499 intermediate, 592 poor).

Design

Systematic review and fixed-effects meta-analysis of prospective trials that assigned adults with AML in first complete remission to allogeneic stem cell transplantation or non-allogeneic therapy on the basis of donor availability, analysed donor versus no-donor; literature searched in March 2009; 24 trials.

Arms

Non-allogeneic therapy (no donor) (control): Non-allogeneic stem cell transplantation therapies (chemotherapy or autologous transplantation)
Allogeneic stem cell transplantation (donor) (experimental): Allogeneic stem cell transplantation

People

Koreth J

RFSHR 0.80 (95% CI 0.74–0.86)OSHR 0.90 (95% CI 0.82–0.97)RFSHR 1.06 (95% CI 0.80–1.42)RFSHR 0.76 (95% CI 0.68–0.85)RFSHR 0.69 (95% CI 0.57–0.84)OSHR 1.07 (95% CI 0.83–1.38)

Show the numbers

Results reported for Allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission: systematic review and meta-analysis of prospective clinical trials
Endpoint	Analysis	Allogeneic stem cell transplantation (donor)	Non-allogeneic therapy (no donor)	Effect
RFSAll trials: AML in first complete remission, donor versus no-donor	primaryKoreth 2009	—	—	HR 0.80 (95% CI 0.74–0.86)Fixed-effects meta-analysis; an HR below 1 favours allogeneic transplantation. Interstudy heterogeneity was not significant.
OSAll trials: AML in first complete remission, donor versus no-donor	primaryKoreth 2009	—	—	HR 0.90 (95% CI 0.82–0.97)
RFSGood-risk AML (cytogenetic risk), donor versus no-donor	primaryKoreth 2009	—	—	HR 1.06 (95% CI 0.80–1.42)
RFSIntermediate-risk AML (cytogenetic risk), donor versus no-donor	primaryKoreth 2009	—	—	HR 0.76 (95% CI 0.68–0.85)
RFSPoor-risk AML (cytogenetic risk), donor versus no-donor	primaryKoreth 2009	—	—	HR 0.69 (95% CI 0.57–0.84)
OSGood-risk AML (cytogenetic risk), donor versus no-donor	primaryKoreth 2009	—	—	HR 1.07 (95% CI 0.83–1.38)
OSIntermediate-risk AML (cytogenetic risk), donor versus no-donor	primaryKoreth 2009	—	—	HR 0.83 (95% CI 0.74–0.93)
OSPoor-risk AML (cytogenetic risk), donor versus no-donor	primaryKoreth 2009	—	—	HR 0.73 (95% CI 0.59–0.90)

Results reported for Allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission: systematic review and meta-analysis of prospective clinical trials
Endpoint	Analysis	Allogeneic stem cell transplantation (donor)	Non-allogeneic therapy (no donor)	Effect
RFSAll trials: AML in first complete remission, donor versus no-donor	primaryKoreth 2009	—	—	HR 0.80 (95% CI 0.74–0.86)Fixed-effects meta-analysis; an HR below 1 favours allogeneic transplantation. Interstudy heterogeneity was not significant.
OSAll trials: AML in first complete remission, donor versus no-donor	primaryKoreth 2009	—	—	HR 0.90 (95% CI 0.82–0.97)
RFSGood-risk AML (cytogenetic risk), donor versus no-donor	primaryKoreth 2009	—	—	HR 1.06 (95% CI 0.80–1.42)
RFSIntermediate-risk AML (cytogenetic risk), donor versus no-donor	primaryKoreth 2009	—	—	HR 0.76 (95% CI 0.68–0.85)
RFSPoor-risk AML (cytogenetic risk), donor versus no-donor	primaryKoreth 2009	—	—	HR 0.69 (95% CI 0.57–0.84)
OSGood-risk AML (cytogenetic risk), donor versus no-donor	primaryKoreth 2009	—	—	HR 1.07 (95% CI 0.83–1.38)
OSIntermediate-risk AML (cytogenetic risk), donor versus no-donor	primaryKoreth 2009	—	—	HR 0.83 (95% CI 0.74–0.93)
OSPoor-risk AML (cytogenetic risk), donor versus no-donor	primaryKoreth 2009	—	—	HR 0.73 (95% CI 0.59–0.90)

Hazard ratio (95% CI) by endpoint. Values below 1 favour the experimental arm.

Data table

Endpoint	HR	95% CI
RFS	0.8	0.74–0.86
OS	0.9	0.82–0.97
RFS	1.06	0.8–1.42
RFS	0.76	0.68–0.85
RFS	0.69	0.57–0.84
OS	1.07	0.83–1.38
OS	0.83	0.74–0.93
OS	0.73	0.59–0.9

Appears in

1979 Allogeneic transplant in first remission of AML

Sources

Koreth J, Schlenk R, Kopecky KJ, Honda S, Sierra J, Djulbegovic BJ, et al. Allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission: systematic review and meta-analysis of prospective clinical trials. JAMA. 2009;301(22):2349-61.
PubMed DOI