Efficacy And Safety Of Hypomethylating Agents And Allogeneic Hematopoietic Stem Cell Transplantation For Patients With Myelodysplastic Syndrome:a Meta-analysis

Objective :To systematically evaluate the efficacy and safety of hypomethylating agents(HMAs)and allogeneic hematopoietic stem cell transplantation(allo-HSCT)in treatments of myelodysplastic syndrome(MDS).Methods:Controlled studies of HMAs and allo-HSCT for MDS were electronically searched in Pubmed,Embase,Cochrane Library,CBM,CNKI,VIP and Wanfang data.The data was processed using Stata 12.0 software after screening literatures,data extraction,and quality assessment.Results:A total of 10 studies involving 1675 patients were included.Meta analysis showed:1.Compared with conventional therapy,HMAs prolonged the median survival of patients with MDS [ES=1.32,95% CI(1.02,1.70),P=0.03].While the survival analysis was performed for each drug,when comparing with conventional therapy,the advantage of the azacitidine group was significant,but that of the decitabine group was not significant.The HMAs group prolonged the time to acute myelogenous leukemia(AML)transformation or death [ES=1.52,95%CI(1.42,1.62),P<0.0001],and effectively improved overall response rate(ORR)in patients with MDS.In addition,there was no significant difference between HMAs group and conventional therapy group in the incidence of grade ?/?adverse event.2.The decitabine group was better than azacitidine group in ORR [OR=0.69,95% CI(0.48,0.99),P= 0.04],and there was no significant difference between the two drugs in the incidence of grade III/IV neutropenia [OR=0.77,95% CI(0.25,2.41),P=0.66].The results of direct and indirect comparison were consistent.3.The 4~5-year survival rate of MDS patients was not significantly different between allo-HSCT group and HMAs group[OR = 2.38,95% CI(0.72,7.92),P = 0.16].Conclusion:The available evidence suggests that HMAs,especially azacitidine,prolong the survival and time to AML transformation or death,and can effectively increase the overall response rate.Decitabine is better than azacitidine in ORR,and there is no significant difference between the two drugs and conventional therapy in the incidence of grade III/IV neutropenia.It is not significantly different between allo-HSCT and HMAs in 4~5-year survival rates in patients with MDS.