TY - JOUR
T1 - Allogeneic hematopoietic cell transplantation is an effective treatment for patients with Richter syndrome
T2 - A systematic review and meta-analysis
AU - Aulakh, Sonikpreet
AU - Reljic, Tea
AU - Yassine, Farah
AU - Ayala, Ernesto
AU - Chavez, Julio C.
AU - Chanan-Khan, Asher
AU - Pinilla-Ibarz, Javier
AU - Kumar, Ambuj
AU - Kharfan-Dabaja, Mohamed A.
N1 - Publisher Copyright:
© 2020 King Faisal Specialist Hospital & Research Centre
PY - 2021/3
Y1 - 2021/3
N2 - Efficacy of conventional chemoimmunotherapy is limited in patients with Richter syndrome (RS) with anticipated median overall survival (OS) of less than 10 months. Allogeneic hematopoietic cell transplantation (allo-HCT) is commonly offered as a consolidative treatment option in RS. To our knowledge, there are no randomized controlled studies that have compared allo-HCT against other therapies in RS; available allo-HCT data are limited to small case series from single-institution or registry studies. We performed a systematic review and meta-analysis to assess the totality of evidence regarding the efficacy (or lack thereof) of allo-HCT for RS. We extracted data on post-allograft outcomes related to benefits (overall response rate [ORR], complete remission [CR], OS, and progression-free survival [PFS]). For harms, data were extracted on non-relapse mortality (NRM) and relapse post-allografting. Our search strategy identified 240 studies, but only four studies (n = 72 patients) met our inclusion criteria. Pooled ORR, CR, OS, and PFS rates were 79%, 33%, 49%, and 30%, respectively. Pooled NRM and relapse rates were 24% and 28%, respectively. Results of this systematic review and meta-analysis indicate that allo-HCT yields encouraging OS in RS, thus remaining a reasonable treatment option in fit patients whose disease demonstrates a chemosensitive response to pre-transplant salvage therapies. Novel strategies are certainly needed to reduce the risk of relapse to further improve outcomes in these patients.
AB - Efficacy of conventional chemoimmunotherapy is limited in patients with Richter syndrome (RS) with anticipated median overall survival (OS) of less than 10 months. Allogeneic hematopoietic cell transplantation (allo-HCT) is commonly offered as a consolidative treatment option in RS. To our knowledge, there are no randomized controlled studies that have compared allo-HCT against other therapies in RS; available allo-HCT data are limited to small case series from single-institution or registry studies. We performed a systematic review and meta-analysis to assess the totality of evidence regarding the efficacy (or lack thereof) of allo-HCT for RS. We extracted data on post-allograft outcomes related to benefits (overall response rate [ORR], complete remission [CR], OS, and progression-free survival [PFS]). For harms, data were extracted on non-relapse mortality (NRM) and relapse post-allografting. Our search strategy identified 240 studies, but only four studies (n = 72 patients) met our inclusion criteria. Pooled ORR, CR, OS, and PFS rates were 79%, 33%, 49%, and 30%, respectively. Pooled NRM and relapse rates were 24% and 28%, respectively. Results of this systematic review and meta-analysis indicate that allo-HCT yields encouraging OS in RS, thus remaining a reasonable treatment option in fit patients whose disease demonstrates a chemosensitive response to pre-transplant salvage therapies. Novel strategies are certainly needed to reduce the risk of relapse to further improve outcomes in these patients.
KW - Allogeneic hematopoietic cell transplantation
KW - Overall survival
KW - Richter syndrome
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U2 - 10.1016/j.hemonc.2020.05.002
DO - 10.1016/j.hemonc.2020.05.002
M3 - Article
C2 - 32473105
AN - SCOPUS:85085753621
SN - 1658-3876
VL - 14
SP - 33
EP - 40
JO - Hematology/ Oncology and Stem Cell Therapy
JF - Hematology/ Oncology and Stem Cell Therapy
IS - 1
ER -