Background: One important therapeutic approach to refractory and relapsed acute myeloid leukemia (R/R AML) is allogeneic hematopoietic stem cell transplantation (allo-HSCT). For patients with R/R AML, however, the effectiveness of conventional conditioning regimens is limited. Of note, intensive chemotherapy sequential with a conditioning regimen has emerged as an effective treatment modality for leukemic cytoreduction in R/R AML. We retrieved relevant studies for systematic review and meta-analysis to understand the effects of intensive chemotherapy sequential with a conditioning regimen for R/R AML patients and reported a case series in our medical center to validate.

Methods: We searched literature from PubMed, Web of Science, EMBASE, the Cochrane Library, and ClinicalTrials.gov through July 2023 and collected 16 relevant cases in the single center to evaluate. We conducted all analyses using R software version 4.3.1. The pooled primary outcomes included the overall-survival (OS) rate and leukemia-free survival (LFS) rate of meta-analysis. The Kaplan-Meier method was used to calculate OS in the single center.

Results: The meta-analysis revealed a pooled 2-year OS rate of 38% (95% confidence interval [CI], 35-42%; I² = 57%, P = 0.01), a LFS rate of 34% (95% CI, 29-40%; I² = 73%; P < 0.01), and a 2-year non-relapse mortality (NRM) rate of 20% (95% CI, 17-23%; I² = 74%; P < 0.01). The 2-year OS rate in our case series was the same as that in our meta-analysis.

Conclusion: For R/R AML patients, intensive chemotherapy with sequential allo-HSCT demonstrated a promising trend toward a better OS and LFS, a reduced relapse rate, and a lower NRM. However, we need a prospective study with an even larger sample size to prove these findings.

Disclosures

No relevant conflicts of interest to declare.

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2024
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