Skip to main content
main-content

01.12.2018 | Primary Research | Ausgabe 1/2018 Open Access

Cancer Cell International 1/2018

Allogeneic stem-cell transplantation for multiple myeloma: a systematic review and meta-analysis from 2007 to 2017

Zeitschrift:
Cancer Cell International > Ausgabe 1/2018
Autoren:
Xuejiao Yin, Liang Tang, Fengjuan Fan, Qinyue Jiang, Chunyan Sun, Yu Hu
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12935-018-0553-8) contains supplementary material, which is available to authorized users.

Abstract

Background

Despite recent advances, multiple myeloma (MM) remains incurable. However, the appearance of allogeneic stem cell transplantation (allo-SCT) through graft-versus-myeloma effect provides a potential way to cure MM to some degree. This systematic review aimed to evaluate the outcome of patients receiving allo-SCT and identified a series of prognostic factors that may affect the outcome of allo-SCT.

Patients/methods

We systematically searched PubMed, Embase, and the Cochrane Library from 2007.01.01 to 2017.05.03 using the keywords ‘allogeneic’ and ‘myeloma’.

Results

A total of 61 clinical trials involving 8698 adult patients were included. The pooled estimates (95% CI) for overall survival (OS) at 1, 2, 3 and 5 years were 70 (95% CI 56–84%), 62 (95% CI 53–71%), 52 (95% CI 44–61%), and 46 (95% CI 40–52%), respectively; for progression-free survival were 51 (95% CI 38–64%), 40 (95% CI 32–48%), 34 (95% CI 27–41%), and 27 (95% CI 23–31%), respectively; and for treatment-related mortality (TRM) were 18 (95% CI 14–21%), 21 (95% CI 17–25%), 20 (95% CI 13–26%), and 27 (95% CI 21–33%), respectively. Additionally, the pooled 100-day TRM was 12 (95% CI 5–18%). The incidences of grades II–IV acute graft-versus-host disease (GVHD) and chronic GVHD were 34 (95% CI 30–37%) and 51 (95% CI 46–56%), respectively. The incidences of relapse rate (RR) and death rate were 50 (95% CI 45–55%) and 51 (95% CI 45–57%), respectively. Importantly, disease progression was the most major cause of death (48%), followed by TRM (44%). The results failed to show an apparent benefit of allo-SCT for standard risk patients, compared with tandem auto-SCT. In contrast, all 14 trials in our study showed that patients with high cytogenetic risk after allo-SCT had similar OS and PFS compared to those with standard risk, suggesting that allo-SCT may overcome the adverse prognosis of high cytogenetic risk.

Conclusion

Due to the lack of consistent survival benefit, allo-SCT should not be considered as a standard of care for newly diagnosed and relapsed standard-risk MM patients. However, for patients with high-risk MM who have a poor long-term prognosis, allo-SCT may be a strong consideration in their initial course of therapy or in first relapse after chemotherapy, when the risk of disease progression may outweigh the transplant-related risks. A large number of prospective randomized controlled trials were needed to prove the benefits of these therapeutic options.
Zusatzmaterial
Additional file 1: Table S1. Characteristics of studies included in the meta-analysis.
Additional file 2: Table S2. Patients’ transplant outcomes of individual clinical trials.
Additional file 3: Table S3. Quality assessment of individual clinical trials.
Additional file 4: Table S4. Begg and Egger test of studies included in the meta-analysis.
Additional file 5: Figure S1. Forest plot of the subgroup overall survival (OS) benefit (auto-allo vs only-allo, auto-allo vs tandem auto, MA vs RIC, high-risk vs standard-risk, first-line vs salvage therapy) (a), (post-transplantation in CR vs in non-CR, at transplantation in CR vs in non-CR, over 50 vs under 50, PBSC vs BM, aGVHD vs non-aGVHD, cGVHD vs non-cGVHD) (b).
Additional file 6: Figure S2. Forest plot of the subgroup progression-free survival (PFS) benefit (auto-allo vs only-allo, auto-allo vs tandem auto, MA vs RIC, high-risk vs standard-risk, first-line vs salvage therapy) (a), (post-transplantation in CR vs in non-CR, at transplantation in CR vs in non-CR, over 50 vs under 50, PBSC vs BM, aGVHD vs non-aGVHD, cGVHD vs non-cGVHD) (b).
Additional file 7: Figure S3. Forest plot of the subgroup relapse rate (RR) (a) and death rate benefit (b) (auto-allo vs only-allo, auto-allo vs tandem auto, MA vs RIC).
Additional file 8: Figure S4. Funnel plot of overall survival (OS) at 1 year (a), 2 years (b), 3 years (c), and 5 years (d).
Additional file 9: Figure S5. Funnel plot of progression-free survival (PFS) at 1 year (a), 2 years (b), 3 years (c),and 5 years (d).
Additional file 10: Figure S6. Funnel plot of treatment-related mortality (TRM) at 100 days (a), 1 year (b), 2 years (c), 3 years (d), and 5 years (e).
Additional file 11: Figure S7. Funnel plot of grade II–IV acute graft-versus-host disease (GVHD) (a), chronic GVHD (b), extensive cGVHD (c), limited cGVHD (d).
Additional file 12: Figure S8. Funnel plot of relapse rate (a) and death (b).
Additional file 13: Figure S9. Sensitivity analysis diagram of overall survival (OS) at 1 year (a), 2 years (b), 3 years (c),and 5 years (d).
Additional file 14: Figure S10. Sensitivity analysis diagram of progression-free survival (PFS) at 1 year (a), 2 years (b), 3 years (c),and 5 years (d).
Additional file 15: Figure S11. Sensitivity analysis diagram of treatment-related mortality (TRM) at 100 days (a), 1 year (b), 2 years (c), 3 years (d),and 5 years (e).
Additional file 16: Figure S12. Sensitivity analysis diagram of grade II–IV acute graft-versus-host disease (GVHD) (a), chronic GVHD (b), extensive cGVHD (c), limited cGVHD (d).
Additional file 17: Figure S13. Sensitivity analysis diagram of relapse rate (a) and death (b).
Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 1/2018

Cancer Cell International 1/2018 Zur Ausgabe