TY - JOUR
T1 - Efficacy of Autologous and Allogeneic Hematopoietic Cell Transplantation in Waldenström Macroglobulinemia
T2 - A Systematic Review and Meta-analysis
AU - Parrondo, Ricardo D.
AU - Reljic, Tea
AU - Iqbal, Madiha
AU - Ayala, Ernesto
AU - Tun, Han W.
AU - Kharfan-Dabaja, Mohamed A.
AU - Kumar, Ambuj
AU - Murthy, Hemant S.
N1 - Publisher Copyright:
© 2020 The Author(s)
PY - 2020/10
Y1 - 2020/10
N2 - Introduction: Waldenström macroglobulinemia (WM) is an IgM-producing lymphoproliferative disorder that remains incurable. Patients with high-risk disease have an overall survival (OS) of less than 3 years. Both autologous (AHCT) and allogeneic (allo-HCT) hematopoietic cell transplantation (HCT) are prescribed for treatment of WM despite a lack of randomized controlled studies. Materials and Methods: We performed a comprehensive literature search using PubMed/Medline and EMBASE on September 10, 2019. Data on clinical outcomes related to benefits and harms was extracted independently by 3 authors. Fifteen studies (8 AHCT [n = 278 patients], 7 allo-HCT [n = 311 patients]) were included in this systematic review/meta-analysis. Results: Pooled OS, progression-free survival (PFS), and nonrelapse mortality (NRM) rates post AHCT were 76% (95% confidence interval [CI], 65%-86%), 55% (95% CI, 42%-68%), and 4% (95% CI, 1%-7%), respectively. Pooled OS, PFS, and NRM rates post allografting were 57% (95% CI, 50%-65%), 49% (95% CI, 42%-56%), and 29% (95% CI, 23%-34%), respectively. OS and PFS rates were reported at 3 to 5 years, and NRM was reported at 1 year in most studies. Pooled ORR (at day 100) post AHCT and allo-HCT were 85% (95% CI, 72%-94%) and 81% (95% CI, 69%-91%), respectively. Pooled complete response rates post AHCT and allo-HCT were 22% (95% CI, 17%-28%) and 26% (95% CI, 7%-50%), respectively. Relapse rates post AHCT and allo-HCT were 42% (95% CI, 30%-55%) and 23% (95% CI, 18%-28%), respectively. Conclusions: Our results show that both AHCT and allo-HCT are effective in the treatment of WM. A 2-fold lower relapse rate but a 7-fold higher NRM was noted for allo-HCT compared with AHCT. The role of transplant in WM needs to be addressed in the era of novel agents. We performed a systematic review and meta-analysis of all the available data to assess the efficacy of autologous (AHCT) and allogeneic (allo-HCT) hematopoietic cell transplantation for Waldenström macroglobulinemia. Both AHCT and allo-HCT are efficacious, resulting in complete response rates of around 20% with allo-HCT affording a 2-fold lower relapse rate, which is offset by a 7-fold higher non-relapse mortality compared with AHCT.
AB - Introduction: Waldenström macroglobulinemia (WM) is an IgM-producing lymphoproliferative disorder that remains incurable. Patients with high-risk disease have an overall survival (OS) of less than 3 years. Both autologous (AHCT) and allogeneic (allo-HCT) hematopoietic cell transplantation (HCT) are prescribed for treatment of WM despite a lack of randomized controlled studies. Materials and Methods: We performed a comprehensive literature search using PubMed/Medline and EMBASE on September 10, 2019. Data on clinical outcomes related to benefits and harms was extracted independently by 3 authors. Fifteen studies (8 AHCT [n = 278 patients], 7 allo-HCT [n = 311 patients]) were included in this systematic review/meta-analysis. Results: Pooled OS, progression-free survival (PFS), and nonrelapse mortality (NRM) rates post AHCT were 76% (95% confidence interval [CI], 65%-86%), 55% (95% CI, 42%-68%), and 4% (95% CI, 1%-7%), respectively. Pooled OS, PFS, and NRM rates post allografting were 57% (95% CI, 50%-65%), 49% (95% CI, 42%-56%), and 29% (95% CI, 23%-34%), respectively. OS and PFS rates were reported at 3 to 5 years, and NRM was reported at 1 year in most studies. Pooled ORR (at day 100) post AHCT and allo-HCT were 85% (95% CI, 72%-94%) and 81% (95% CI, 69%-91%), respectively. Pooled complete response rates post AHCT and allo-HCT were 22% (95% CI, 17%-28%) and 26% (95% CI, 7%-50%), respectively. Relapse rates post AHCT and allo-HCT were 42% (95% CI, 30%-55%) and 23% (95% CI, 18%-28%), respectively. Conclusions: Our results show that both AHCT and allo-HCT are effective in the treatment of WM. A 2-fold lower relapse rate but a 7-fold higher NRM was noted for allo-HCT compared with AHCT. The role of transplant in WM needs to be addressed in the era of novel agents. We performed a systematic review and meta-analysis of all the available data to assess the efficacy of autologous (AHCT) and allogeneic (allo-HCT) hematopoietic cell transplantation for Waldenström macroglobulinemia. Both AHCT and allo-HCT are efficacious, resulting in complete response rates of around 20% with allo-HCT affording a 2-fold lower relapse rate, which is offset by a 7-fold higher non-relapse mortality compared with AHCT.
KW - Allogeneic hematopoietic cell transplantation
KW - Autologous hematopoietic cell transplantation
KW - Non-Hodgkin lymphoma
KW - Plasma cell dyscrasia
KW - Waldenstrom Macroglobulinemia
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U2 - 10.1016/j.clml.2020.05.021
DO - 10.1016/j.clml.2020.05.021
M3 - Article
C2 - 32616401
AN - SCOPUS:85087218403
SN - 2152-2650
VL - 20
SP - e694-e711
JO - Clinical Lymphoma, Myeloma and Leukemia
JF - Clinical Lymphoma, Myeloma and Leukemia
IS - 10
ER -