Outcomes of Allogeneic Stem Cell Transplantation in Elderly Patients with Acute Myeloid Leukemia: A Systematic Review and Meta-analysis.
Outcomes of Allogeneic Stem Cell Transplantation in Elderly Patients with Acute Myeloid Leukemia: A Systematic Review and Meta-analysis.
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DOI：
10.1016/j.bbmt.2015.10.019
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发表时间：
2016-04
期刊：
影响因子：
--
通讯作者：
DiPersio JF
中科院分区：
文献类型：
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作者：
Rashidi A;Ebadi M;Colditz GA;DiPersio JF
A large number of elderly patients with acute myeloid leukemia (AML) are not offered curative intent treatments such as allogeneic stem cell transplantation (SCT) due to fears of toxicity and perceived futility of intensive treatment. Therefore, the outcomes of SCT in elderly AML patients remain poorly defined. We performed a meta-analysis of all previous articles up until September 22, 2015 of SCT in AML patients >60 years. The primary endpoints were relapse-free survival (RFS) and overall survival (OS) at 6 months and 1, 2, and 3 years. A total of 13 studies (749 patients) were included. The pooled estimates (95%CI) for RFS at 6 months, 1 year, 2 years, and 3 years were 62 (54–69)%, 47 (42–53)%, 44 (33–55)%, and 35 (26–45)%, respectively. The corresponding numbers for OS were 73 (66–79)%, 58 (50–65)%, 45 (35–54)%, and 38 (29–48)%, respectively. We found no evidence for publication bias in our primary endpoints with the exception of relapse where there appeared to be a relative lack of small studies with high relapse rates. Sensitivity analysis did not identify an overtly influential study for our primary endpoints with one exception in 2-year RFS analysis. The present analysis argues against significant publication bias and demonstrates consistency among reports despite differences in patient-, disease-, center-, and transplant-related characteristics. Our results suggest that reduced-intensity SCT is a viable treatment option for elderly AML patients with a 3-year RFS of 35% for those over the age of 60. These results argue against using age per se as the sole criterion against SCT and would help remove some of the barriers that often preclude curative intent treatment. Correct identification of patients who would benefit from SCT can improve outcomes in this frequently undertreated population.
