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Comparative study on allogeneic with autologous hematopoietic stem cell transplantation in adult patients with Philadelphia chromosome–positive acute lymphoblastic leukemia in the era of TKIs: a systematic review and meta-analysis

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Abstract

In the era of tyrosine kinase inhibitors (TKIs), allogeneic hematopoietic stem cell transplantation (allo-HSCT) is recommended as a standard approach for Philadelphia chromosome–positive acute lymphoblastic leukemia (Ph+ ALL) achieving complete remission (CR). However, the role of autologous hematopoietic stem cell transplantation (auto-HSCT) in adult patients achieving complete molecular remission (CMR) is an alternative, less toxic treatment options, especially for the patients who lack suitable donors and are unfit for allo-HSCT. Thus, we conducted a systematic review and meta-analysis to compare the efficacy of allo-HSCT and auto-HSCT for the treatment of adult patients with Ph+ ALL. We searched the PubMed, Embase, Scopus, and Cochrane Library for studies published before June 2019 without language restriction. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for overall survival (OS) and relapse-free survival (RFS) and odds ratios (ORs) and 95% CIs for relapse rate (RR) and treatment-related mortality (TRM). Four prospective studies and one retrospective study were included with a total of 810 patients. We found auto-HSCT was superior to allo-HSCT in OS (HR = 1.42, 95% CI: 1.06–1.91, P = 0.02), and there was no difference between allo-HSCT and auto-HSCT for RFS (HR = 1.10, 95% CI: 0.86–1.40, P = 0.44) and RR (OR = 0.53, 95% CI: 0.22–1.26, P = 0.15). The risk of TRM for patients undergoing allo-HSCT was significantly higher than that of the patients who received auto-HSCT (OR = 5.06, 95% CI: 1.03–24.75, P = 0.05). Our meta-analysis shows that auto-HSCT may be an attractive and alternative treatment option for adult Ph+ ALL patients achieving CMR, with similar or better outcomes than allo-HSCT in the era of TKIs.

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Funding

This study is supported by the Grant of Sichuan Science and Technology Key Research and Development Project, the Ministry of Science and Technology of Sichuan, China (Grant No. 2017SZ0051).

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  1. Haichen Wei and Pu Kuang contributed equally to this work.

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  1. Department of Hematology, Institute of Hematology, West China Hospital of Sichuan University, #37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan, China

    Haichen Wei, Pu Kuang & Ting Liu

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TL and HW were responsible for the conception and design of the study. HW and PK performed the literature search, study selection, data collection, and analysis. HW and PK drafted the manuscript; HW, PK, and TL revised the manuscript critically. All authors are involved in reviewing and revising the manuscript. All authors have read and approved the final manuscript.

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Correspondence to Ting Liu.

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Wei, H., Kuang, P. & Liu, T. Comparative study on allogeneic with autologous hematopoietic stem cell transplantation in adult patients with Philadelphia chromosome–positive acute lymphoblastic leukemia in the era of TKIs: a systematic review and meta-analysis. Ann Hematol 99, 2619–2628 (2020). https://doi.org/10.1007/s00277-020-04258-1

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