Meta-analysis of Therapeutic Approaches in Acute Myeloid Leukemia: Unveiling Trends and Predictors of Treatment Response.

IF 1.8 4区医学 Q4 ONCOLOGY

American Journal of Clinical Oncology-Cancer Clinical Trials Pub Date : 2025-05-01 Epub Date: 2025-03-31 DOI:10.1097/COC.0000000000001169

Zaheer Qureshi, Abdur Jamil, Faryal Altaf, Rimsha Siddique

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引用次数: 0

Abstract

Objective: To elucidate emerging trends and predictors for optimizing treatment strategies for acute myeloid leukemia (AML).

Method: A literature search was conducted on PubMed, Embase, Web of Science, and Google Scholar databases. Bias assessment was conducted using Cochrane's risk of bias tool, while statistical analyses were performed using Review Manager and Comprehensive Meta-Analysis software.

Results: We included 44 studies and the pooled results showed that high-dose cytarabine (HDAC) in induction therapy significantly improved the complete remission (CR) rate than standard-dose cytarabine (SDAC) in younger adults but not older adults (OR: 1.29, 95% CI: 1.12-1.49, P =0.0004 and OR: 1.02, 95% CI: 0.80-1.29, P =0.87, respectively). In consolidation therapy, HDAC showed a significant benefit in event-free survival (EFS) over SDAC (RR: 1.30, 95% CI: 1.04-1.62, P =0.02). The pooled analysis also revealed that idarubicin (IDR) was associated with improved CR rates than daunorubicin (DNR) (OR: 1.34, 95% CI: 1.02-1.76, P =0.04). However, the results do not substantiate the claim that IDR is better than mitoxantrone (MTZ) or that DNR is superior to MTZ in inducing CR (OR: 0.88, 95% CI: 0.72-1.08, P =0.22 and OR: 0.85, 95% CI: 0.72-1.01, P =0.06, respectively). The evidence has also shown that the pooled composite complete response (CRc) rates for FLT3 inhibitors such as sorafenib, gilteritinib, and quizartinib were 56%, 31%, and 36%, respectively. The pooled results further showed that the overall CRc for patients receiving IDH inhibitors and immune checkpoint inhibitors were 49.6% (95% CI: 37-63) and 26% (95% CI: 18.7-35), respectively.

Conclusion: Chemotherapy, targeted therapy, and immunotherapy are valuable treatment options for AML patients. However, the efficacy of these AML treatments may vary depending on AML status and patient characteristics such as age and cytogenetic risk.

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急性髓系白血病治疗方法的荟萃分析：揭示治疗反应的趋势和预测因素。

目的：阐明急性髓性白血病（AML）治疗策略优化的新趋势和预测因素。方法：在PubMed、Embase、Web of Science、谷歌Scholar数据库中进行文献检索。偏倚评估采用Cochrane偏倚风险评估工具，统计分析采用Review Manager和Comprehensive Meta-Analysis软件。结果：我们纳入了44项研究，汇总结果显示，与标准剂量阿糖胞苷（SDAC）相比，高剂量阿糖胞苷（HDAC）在诱导治疗中显著提高了年轻人的完全缓解率（CR），而在老年人中则没有（OR: 1.29, 95% CI: 1.12-1.49， P=0.0004; OR: 1.02, 95% CI: 0.80-1.29， P=0.87）。在巩固治疗中，与SDAC相比，HDAC在无事件生存（EFS）方面显示出显著的益处（RR: 1.30, 95% CI: 1.04-1.62， P=0.02）。合并分析还显示，与柔红霉素（DNR）相比，去甲红霉素（IDR）与改善CR率相关（OR: 1.34, 95% CI: 1.02-1.76， P=0.04）。然而，结果并不能证实IDR优于米托蒽醌（MTZ）或DNR优于MTZ诱导CR （or: 0.88, 95% CI: 0.72-1.08， P=0.22和or: 0.85, 95% CI: 0.72-1.01， P=0.06）。证据还表明，FLT3抑制剂（如索拉非尼、吉特替尼和奎萨替尼）的综合完全缓解率分别为56%、31%和36%。综合结果进一步显示，接受IDH抑制剂和免疫检查点抑制剂的患者的总体结直肠癌发生率分别为49.6% （95% CI: 37-63）和26% （95% CI: 18.7-35）。结论：化疗、靶向治疗和免疫治疗是AML患者有价值的治疗选择。然而，这些AML治疗的疗效可能因AML状态和患者特征（如年龄和细胞遗传风险）而异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Clinical Oncology-Cancer Clinical Trials 医学-肿瘤学

CiteScore

4.90

自引率

0.00%

发文量

130

审稿时长

4-8 weeks

期刊介绍： American Journal of Clinical Oncology is a multidisciplinary journal for cancer surgeons, radiation oncologists, medical oncologists, GYN oncologists, and pediatric oncologists. The emphasis of AJCO is on combined modality multidisciplinary loco-regional management of cancer. The journal also gives emphasis to translational research, outcome studies, and cost utility analyses, and includes opinion pieces and review articles. The editorial board includes a large number of distinguished surgeons, radiation oncologists, medical oncologists, GYN oncologists, pediatric oncologists, and others who are internationally recognized for expertise in their fields.