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

Biol Blood Marrow Transplant. 2020 Jun;26(6):e138-e141. doi: 10.1016/j.bbmt.2020.03.003. Epub 2020 Mar 12.

Authors

Armin Rashidi¹, Mohamad A Meybodi², Wenhao Cao³, Haitao Chu³, Erica D Warlick², Steven Devine⁴, Marcelo C Pasquini⁵, Daniel J Weisdorf², Mehdi Hamadani⁵

Affiliations

¹ Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota. Electronic address: arashidi@umn.edu.
² Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
³ Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
⁴ Center for International Blood and Marrow Transplantation Research, Minneapolis, Minnesota.
⁵ BMT & Cellular Therapy Program, Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.

PMID: 32171885
DOI: 10.1016/j.bbmt.2020.03.003

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.

Keywords: Meta-analysis; Myeloablative; Myelodysplastic syndromes; Reduced intensity; Transplantation.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Hematopoietic Stem Cell Transplantation*
Humans
Myelodysplastic Syndromes* / therapy
Recurrence
Transplantation Conditioning