Meta-analysis of the benefit of hypomethylating agents before allogeneic hematopoietic stem cell transplantation in myelodysplastic syndromes

Abstract

Hypomethylating agents (HMAs) are effective therapies in myelodysplastic syndromes (MDS), but allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only way to cure MDS. According to the current literature, it is difficult to confirm whether HMAs bridging therapy is beneficial for MDS patients receiving allo-HSCT. Therefore, we tried to evaluate the effect of HMAs on long-term survival of the MDS patients. Databases, including PubMed, Embase Ovid, and the Cochrane Library, were searched for studies published up to January 10, 2021. Patients who accepted HMAs bridging to allo-HSCT were defined as experimental group, while patients who received the best supportive care (BSC) before allo-HSCT were control group. Overall survival (OS) was the primary end point. Seven studies were included in the final analysis. The final results showed no OS differences between patients accepted HMAs before allo-HSCT and those received BSC (HR = 0.86, 95% CI: 0.64–1.15, p = 0.32), indicating that MDS patients' long-term survival did not benefit from HMAs bridging therapy before allo-HSCT. This conclusion needs to be further verified by a large number of prospective randomized controlled trials, which have guiding significance for the treatment of MDS patients.

Therapeutic options in high-risk myelodysplastic syndrome

“…HMAs are recommended to use for patients with HR-MDS who are not eligible for intensive treatment, resistant to immunosuppressive schemes, or as a bridging treatment before allo-HSCT. However, in the meta-analysis of Liu et al [31], they observed no differences between OS in patients with HMAs bridging to allo-HSCT and best supportive care before transplantation [hazard ratio (HR) = 0.86, 95% confidence interval (CI): 0.64-1.15, p = 0.32]. Evaluation of the effect of this therapeutic method on OS requires further prospective studies with a longer observation period.…”

Allogeneic stem cell transplantation for patients with myelodysplastic syndromes

“…A meta‐analysis of seven studies showed no survival differences between patients with MDS treated with pre allo‐HSCT HMA and those receiving pre allo‐HSCT best supportive care (HR = 0.86, 95% CI: 0.64–1.15, p = .32) 60 . However, the fact that all studies included in this meta‐analysis were retrospective and with relatively small numbers of patients raises questions about significant biases that limit the strength of the conclusions.…”