Efficacy of bone marrow transplantation in treating acute myeloid leukemia: a systematic review and meta-analysis

Objective: To systematically assess the efficacy of hematopoietic stem cell transplantation (HSCT) and bone marrow transplantation (BMT) in treating acute myeloid leukemia (AML). Methods: PubMed, EMBASE, ScienceDirect, Cochrane Library, China National Knowledge Infrastructure (CNKI), China VIP database, Wanfang database and China Biomedical Literature Database (CBM) were searched for case-control trials of bone marrow HSCT and peripheral HSCT (PHSCT) for treating AML. Two independent researchers extracted the data between January 2000 and May 2022. Each retrieved article was assessed according to the bias risk defined in Cochrane Handbook 5.3, and data were analyzed by meta-analysis using RevMan5.3. Results: Through computer database retrieval, 7 clinical controlled studies were included, with 1280 samples. A meta-analysis was conducted on the survival rates. The PHSCT and the BMT groups showed no noticeable difference in overall survival (OS) and disease -free survival (DFS) rates (P > 0.05). The incidence of acute graft-versus-host disease (GVHD) and chronic GVHD in the BMT group was noticeably lower (P < 0.05). The disease recurrence rate in tthe BMT group was lower (P < 0.05), but no noticeable differences were found in recurrence-related mortality (P > 0.05). Furthermore, there was also no noticeable difference in non-relapse-related mortality (P > 0.05). Funnel charts were drawn on the basis of OS rate, DFS rate, incidences of acute GVHD and chronic GVHD, and recurrence. Afterwards publication bias analysis was carried out. Symmetry presented in the majority of the funnel charts and asymmetry was seen in a few, suggesting possible publication bias in the selected literature because of the small sample and the heterogeneity. Conclusion: BMT can be used as an effective treatment for patients with AML, because it can reduce the recurrence rate and the incidence of complications while ensuring a curative effect, suggesting that BMT is worth popularizing in the clinic. Longer follow-up studies are needed to provide more support for the clinical application of BMT in AML patients.

Automated summary

This study systematically assesses the efficacy of hematopoietic stem cell transplantation (HSCT) and bone marrow transplantation (BMT) in treating acute myeloid leukemia (AML). Seven clinical controlled studies with 1280 samples were included. The meta-analysis results show that there is no significant difference in overall survival (OS) and disease-free survival (DFS) rates between the peripheral HSCT (PHSCT) group and the BMT group. The BMT group has lower incidence of acute graft-versus-host disease (GVHD), chronic GVHD, and disease recurrence. However, there is no noticeable difference in recurrence-related mortality and non-relapse-related mortality. Some funnel plots suggest possible publication bias due to small sample size and heterogeneity. In conclusion, BMT can be considered an effective treatment for AML patients, reducing recurrence and complications while ensuring a curative effect. Longer follow-up studies are needed to further support its clinical application.