Myeloablative versus Reduced-Intensity Hematopoietic Cell Transplantation in Myelodysplastic Syndromes: Systematic Review and Meta-analysis

Armin Rashidi; Mohamad A. Meybodi; Wenhao Cao; Haitao Chu; Erica D. Warlick; Steven Devine; Marcelo C. Pasquini; Daniel J. Weisdorf; Mehdi Hamadani

doi:10.1016/j.bbmt.2020.03.003

Myeloablative versus Reduced-Intensity Hematopoietic Cell Transplantation in Myelodysplastic Syndromes: Systematic Review and Meta-analysis

Armin Rashidi, Mohamad A. Meybodi, Wenhao Cao, Haitao Chu, Erica D. Warlick, Steven Devine, Marcelo C. Pasquini, Daniel J. Weisdorf, Mehdi Hamadani

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

In a systematic review and meta-analysis, we compared allogeneic transplant outcomes after myeloablative conditioning (MAC) versus reduced-intensity conditioning (RIC) in patients with myelodysplastic syndromes. Only 2 published randomized clinical trials were found, with a pooled sample size of 183 (RIC, 92; MAC, 91). Both studies suggested an overall survival advantage after RIC, with a pooled hazard ratio (HR) of. 67 (95% confidence interval [CI],. 41 to 1.09) for RIC versus MAC. Relapse results were also concordant, with a pooled HR of 1.55 (95% CI,. 74 to 3.25) for RIC versus MAC. Neither result was statistically significant. Comparisons for other outcomes were unremarkable. In conclusion, the evidence for the optimal conditioning intensity in myelodysplastic syndromes is weak. Post-transplant maintenance strategies and incorporation of genomic information into decision-making may improve post-transplant outcomes.

Original language	English (US)
Pages (from-to)	e138-e141
Journal	Biology of Blood and Marrow Transplantation
Volume	26
Issue number	6
DOIs	https://doi.org/10.1016/j.bbmt.2020.03.003
State	Published - Jun 2020

Bibliographical note

Funding Information:
Financial disclosure: The authors have nothing to disclose. Conflict of interest statement: M.H. reports research support/funding from Takeda Pharmaceutical Company, Otsuka Pharmaceutical, Spectrum Pharmaceuticals, and Astellas Pharma; consultant for Janssen R&D, Incyte Corporation, ADC Therapeutics, Celgene Corporation, Pharmacyclics, Magenta Therapeutics, Omeros, AbGenomics, Verastem, and TeneoBio; speaker's bureau for Sanofi Genzyme and AstraZeneca. Authorship statement: A.R. and M.H. designed the study. A.R. M.A.M. and W.C. wrote the manuscript. M.A.M. conducted the literature search. M.A.M. and A.R. extracted the data. W.C. and H.C. performed the meta-analysis. E.D.W. S.D. M.C.P. D.J.W. and M.H. critically evaluated the results and manuscript. Financial disclosure: See Acknowledgments on page e141.

Publisher Copyright:
© 2020 American Society for Transplantation and Cellular Therapy

Keywords

Meta-analysis
Myeloablative
Myelodysplastic syndromes
Reduced intensity
Transplantation

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10.1016/j.bbmt.2020.03.003

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Rashidi, A., Meybodi, M. A., Cao, W., Chu, H., Warlick, E. D., Devine, S., Pasquini, M. C., Weisdorf, D. J., & Hamadani, M. (2020). Myeloablative versus Reduced-Intensity Hematopoietic Cell Transplantation in Myelodysplastic Syndromes: Systematic Review and Meta-analysis. Biology of Blood and Marrow Transplantation, 26(6), e138-e141. https://doi.org/10.1016/j.bbmt.2020.03.003

Rashidi, A, Meybodi, MA, Cao, W, Chu, H, Warlick, ED, Devine, S, Pasquini, MC, Weisdorf, DJ & Hamadani, M 2020, 'Myeloablative versus Reduced-Intensity Hematopoietic Cell Transplantation in Myelodysplastic Syndromes: Systematic Review and Meta-analysis', Biology of Blood and Marrow Transplantation, vol. 26, no. 6, pp. e138-e141. https://doi.org/10.1016/j.bbmt.2020.03.003

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abstract = "In a systematic review and meta-analysis, we compared allogeneic transplant outcomes after myeloablative conditioning (MAC) versus reduced-intensity conditioning (RIC) in patients with myelodysplastic syndromes. Only 2 published randomized clinical trials were found, with a pooled sample size of 183 (RIC, 92; MAC, 91). Both studies suggested an overall survival advantage after RIC, with a pooled hazard ratio (HR) of. 67 (95% confidence interval [CI],. 41 to 1.09) for RIC versus MAC. Relapse results were also concordant, with a pooled HR of 1.55 (95% CI,. 74 to 3.25) for RIC versus MAC. Neither result was statistically significant. Comparisons for other outcomes were unremarkable. In conclusion, the evidence for the optimal conditioning intensity in myelodysplastic syndromes is weak. Post-transplant maintenance strategies and incorporation of genomic information into decision-making may improve post-transplant outcomes.",

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note = "Funding Information: Financial disclosure: The authors have nothing to disclose. Conflict of interest statement: M.H. reports research support/funding from Takeda Pharmaceutical Company, Otsuka Pharmaceutical, Spectrum Pharmaceuticals, and Astellas Pharma; consultant for Janssen R&D, Incyte Corporation, ADC Therapeutics, Celgene Corporation, Pharmacyclics, Magenta Therapeutics, Omeros, AbGenomics, Verastem, and TeneoBio; speaker's bureau for Sanofi Genzyme and AstraZeneca. Authorship statement: A.R. and M.H. designed the study. A.R. M.A.M. and W.C. wrote the manuscript. M.A.M. conducted the literature search. M.A.M. and A.R. extracted the data. W.C. and H.C. performed the meta-analysis. E.D.W. S.D. M.C.P. D.J.W. and M.H. critically evaluated the results and manuscript. Financial disclosure: See Acknowledgments on page e141. Publisher Copyright: {\textcopyright} 2020 American Society for Transplantation and Cellular Therapy",

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AU - Warlick, Erica D.

AU - Devine, Steven

AU - Pasquini, Marcelo C.

AU - Weisdorf, Daniel J.

AU - Hamadani, Mehdi

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N2 - In a systematic review and meta-analysis, we compared allogeneic transplant outcomes after myeloablative conditioning (MAC) versus reduced-intensity conditioning (RIC) in patients with myelodysplastic syndromes. Only 2 published randomized clinical trials were found, with a pooled sample size of 183 (RIC, 92; MAC, 91). Both studies suggested an overall survival advantage after RIC, with a pooled hazard ratio (HR) of. 67 (95% confidence interval [CI],. 41 to 1.09) for RIC versus MAC. Relapse results were also concordant, with a pooled HR of 1.55 (95% CI,. 74 to 3.25) for RIC versus MAC. Neither result was statistically significant. Comparisons for other outcomes were unremarkable. In conclusion, the evidence for the optimal conditioning intensity in myelodysplastic syndromes is weak. Post-transplant maintenance strategies and incorporation of genomic information into decision-making may improve post-transplant outcomes.

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KW - Reduced intensity

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Myeloablative versus Reduced-Intensity Hematopoietic Cell Transplantation in Myelodysplastic Syndromes: Systematic Review and Meta-analysis

Abstract

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Keywords

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