Survival Outcomes of Hematopoietic Stem Cell Transplantation (HSCT) and Imatinib in the Treatment of Chronic Myeloid Leukemia Treatment in China: a Meta-Analysis.

HSCT(mainly allogeneic)is still used as a treatment option, and in some cases, first line option for chronic myeloid leukemia (CML) in China. The objective of this study is to understand the treatment outcomes of HSCT and imatinib for CML in China.

All published original China CML research was reviewed and included in this analysis if they met the following criteria: studies are from institutions in China; HSCT or imatinib was used to treat CML; contained data on treatment effect and survival; the sample size reported was ≥ 5 patients. Meta-analysis was used to analyze the pooled data. The survival rate of CML patients for HSCT and imatinib were compared by confidence interval method.

The study reviewed 46 HSCT papers and 66 imatinib papers. Meta survival analysis was conducted for 6 HSCT and 6 imatinib studies that had completed 5-year survival data. All 12 papers studied CML patients treated from the top tier hospitals in China. Totally, 263 HSCT patients

HSCT(mainly allogeneic)is still used as a treatment option, and in some cases, first line option for chronic myeloid leukemia (CML) in China. The objective of this study is to understand the treatment outcomes of HSCT and imatinib for CML in China.

All published original China CML research was reviewed and included in this analysis if they met the following criteria: studies are from institutions in China; HSCT or imatinib was used to treat CML; contained data on treatment effect and survival; the sample size reported was ≥ 5 patients. Meta-analysis was used to analyze the pooled data. The survival rate of CML patients for HSCT and imatinib were compared by confidence interval method.

The study reviewed 46 HSCT papers and 66 imatinib papers. Meta survival analysis was conducted for 6 HSCT and 6 imatinib studies that had completed 5-year survival data. All 12 papers studied CML patients treated from the top tier hospitals in China. Totally, 263 HSCT patients (227 CP, 23AP, 5 BC) and 718 imatinib patients (442CP, 145AP, 131BC) were involved in the meta-analysis. The median age was 33.5 years (range 14-57 years) for HSCT patients and 41,5 years (range 5-79 years) for imatinib patients. Both HSCT and imatinib achieved much better results in chronic phase (CP) compared to other phases (AP or BC) of CML.HSCT for CML-CP achieved estimated 73% survival rate (95% CI 67-79%) at 5 years. The acute graft versus host disease (GVHD) rate ranged from 24% to 63%; chronic GVHD rate ranged from10% to 57%; mortality due to transplantation ranged from 16% to 34%; mortality due to relapse ranged from 2% to 10%. In CML-CP patients treated with imatinib therapy, 5-year KM-estimated survival rate was 88% (95% CI 84 - 92%). Imatinib was most effective in newly diagnosed CML-CP patients and was very effective in CML patients with failed interferon therapy or relapse after allogeneic stem cell transplantation. For CML-CP patients, imatinib showed significantly better survival than HSCT (88% vs. 73%, p<0.05). Most of the nonhematological adverse reactions of imatinib therapy were mild and tolerable. The most frequently reported grade 3 or 4 adverse reactions in imatinib patients were leukocytopenia and thrombocytopenia.

Based on this meta-analysis, imatinib demonstrated significantly better long-term survival outcomes than HSCT in China. Therefore, imatinib should be the 1st line treatment option for CML patients and HSCT should be used as the 2nd line treatment as the second generation tyrosine kinase inhibitors.

No relevant conflicts of interest to declare.