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Reduced intensity conditioning of allogeneic hematopoietic stem cell transplantation for myelodysplastic syndrome and acute myeloid leukemia in patients older than 50 years of age: a systematic review and meta-analysis

  • Original Article – Clinical Oncology
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Abstract

Purpose

A systematic review and meta-analysis were performed to explore the efficacy and safety of allogeneic hematopoietic stem cell transplantation with a reduced intensity conditioning regimen in elderly patients with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML).

Methods

Overall survival (OS) and event-free survival (EFS) were established as the primary endpoints for directly assessing the efficacy, and non-relapse mortality (NRM) for safety. The eligible patients were at or above 50 years of age, and the outcomes of the typical elderly patients (≥60 years) were analyzed individually.

Results

The pooled estimates (95% confidence interval (CI)) for 1-year OS, EFS and NRM were 65 (55–74)  %, 50 (44–55)  % and 26 (21–30)  %, respectively; as for the patients ≥60 years of age, these were 63 (53–72) %, 46 (41–50)  % and 28 (23–32) %, respectively. No significantly statistical difference achieved between MDS and AML patients in 1-year EFS and NRM [relative risk (RR) 0.91, 95% CI 0.80–1.04; P = 0.172 and RR 1.18, 95% CI 0.82–1.69; P = 0.365]. The patients with lower diseases risk had the possibility of higher OS rate at ≥ 3 years than those with higher diseases risk (RR 1.37, 95% CI 0.95–1.97; P = 0.088). The patients had significantly higher 2-year OS and EFS rates in complete remission (CR, CR1 and CR2) at transplantation compared to those with advanced diseases (P < 0.05).

Conclusions

RIC-alloHSCT is a feasible treatment option for the patients older than 50 year of age with MDS and AML. Advanced diseases status and higher diseases risk may be the poor factors for prognosis.

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Author notes

  1. Zhi-hui Zhang, Xin-yue Lian and Dong-ming Yao contributed equally to this work.

Authors and Affiliations

  1. Department of Hematology, Affiliated People’s Hospital of Jiangsu University, 8 Dianli Rd., Zhenjiang, 212002, Jiangsu, People’s Republic of China

    Zhi-hui Zhang, Xin-yue Lian, Wei Zhang & Jun Qian

  2. Laboratory Center, Affiliated People’s Hospital of Jiangsu University, 8 Dianli Rd., Zhenjiang, 212002, Jiangsu, People’s Republic of China

    Dong-ming Yao, Pin-fang He, Ji-chun Ma, Zi-jun Xu, Hong Guo & Jiang Lin

  3. The Key Lab of Precision Diagnosis and Treatment of Zhenjiang City, Zhenjiang, Jiangsu, People’s Republic of China

    Zhi-hui Zhang, Xin-yue Lian, Dong-ming Yao, Pin-fang He, Ji-chun Ma, Zi-jun Xu, Hong Guo, Wei Zhang, Jiang Lin & Jun Qian

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  1. Zhi-hui Zhang
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Correspondence to Jiang Lin or Jun Qian.

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Funding

This work was supported by National Natural Science foundation of China (81270630), Special Funds of “Ke Jiao Qiang Wei” Project of Jiangsu Province, 333 Project of Jiangsu Province (BRA2016131), Six Talent Peaks Project in Jiangsu Province (2015-WSN-115), China Postdoctoral Science Foundation funded project (2016M601748), Social Development Foundation of Zhenjiang (SH2015058, SH2016045, SH2016046), Social Development Foundation of Kunshan (KS1624), Key Medical Talent Program of Zhenjiang City.

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The authors declare no conflict of interest.

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The studies included declare all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Zhang, Zh., Lian, Xy., Yao, Dm. et al. Reduced intensity conditioning of allogeneic hematopoietic stem cell transplantation for myelodysplastic syndrome and acute myeloid leukemia in patients older than 50 years of age: a systematic review and meta-analysis. J Cancer Res Clin Oncol 143, 1853–1864 (2017). https://doi.org/10.1007/s00432-017-2429-z

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