Outcomes with Allogeneic Hematopoietic Stem Cell Transplantation in Therapy Related Myeloid Neoplasms: A Systematic Review and Meta-Analysis

Abstract In this meta-analysis and systematic review, 7785 patients from 33 original studies reporting outcomes of therapy- related myeloid neoplasms (t-MN) including therapy-related acute myeloid leukemia (t-AML) and therapy-related myelodysplastic syndrome (t-MDS) were included. The survival data were retrieved from Kaplan-Meier (KM) curves to calculate the overall survival (OS) and disease-free survival (DFS) probabilities. 67.3% (n = 5241) of the patients had t-AML. 26.5% (n = 2076) had t-MDS, and 6% had a mixed presentation (n = 468). The age of the patients ranged from 2 to 89 years and 61.7% were females. The pooled median OS was 16.9 months (95% CI: 13.7–21.1) and the estimated mean OS was 46.0 months (95% CI: 42.1–49.6). The pooled median DFS was 8.8 months (95% CI: 7.4–11.2) and mean DFS was 37.8 months (95% CI: 33.4–41.9). The pooled proportion of acute graft versus host disease (aGvHD) was 34% (95% CI: 0.35–0.45, I2: 91.71%, p < 0.0001). Relapse of the myeloid neoplasm was the most common cause of mortality, followed by infections, relapse of the underlying disease, and GvHD. Despite complications, allo-HCT is still the curative treatment option with better outcomes compared to conventional chemotherapy in t-MN. Timely transplants in carefully selected patients with post-HCT interventions could improve outcomes.