Maintenance therapy after allogeneic hematopoietic transplant for acute myeloid leukemia: a systematic review and meta-analysis

Figures & data

Figure 1. Flow diagram of publications identified for study and exclusions. RCT: randomized control trial.

Table 1. Characteristics of included trials.

Study	AML type eligibility criteria	Start of maintenance post transplant (days)	Primary endpoint	Length of follow up (months)	Study drug	Dose and schedule of study drug	Number of patients included	Age (Median, range)	Sex (male, percentage) (%)
Burchert 2020	Flt3-ITD mutated AML	60–100	RFS	42	Sorafenib	PO 800 mg/d¥; for 24 months	43	54 (24–75)	42
					Placebo		40	54 (19–76)	58
Maziarz 2020	Flt3-ITD mutated AML	28–60	RFS	24	Midostaurin	PO 100 mg/d; for 12 months	30	48 (20–61)	53
					SOC		30	56 (20–68)	60
Xuan 2020	Flt3-ITD mutated AML	30–60	relapse rate	21	Sorafenib	PO 800 mg/d¥; till day + 180 from transplant	100	35 (26–42)	50
					SOC		102	35 (26–43)	51
Gao 2020	High risk AML	60–100	relapse rate	28	Decitabine	IV 5 mg/m^2 on days 1–5, every 6–8 weeks; up to 6 cycles§	102	30(3–62)	56
					SOC		102	28(2–52)	60
Oran 2020	High risk AML/MDS	42–100	RFS	52	Azacitidine	SC 32 mg/m^2 for 5 days every 4 weeks; for 12 months	93	57 (19–72)	59
					SOC		94	58 (20–75)	61

AML: acute myeloid leukemia; RFS: relapse free survival; GCSF: granulocyte colony stimulating factor; SOC: standard of care;

MDS: myelodysplatic syndrome; PO: per os; IV: intravenous; SC: subcutaneous.

¥ After dose escalation.

§ patients also received SC rhG-CSF 100 mg/m² on days 0–5 of each cycle.

Table 2. Transplant characteristics of included trials.

Study	Treatment regimen	Number of patients randomized	Remission at transplant		MRD status at transplant		Conditioning regimen		Donor type
			CHR	No CHR	MRD+	MRD-	MAC	RIC	MSD	MUD	Haplo
Burchert 2020	Sorafenib	43	36	7	27	9	18	25	8	35	0
	Placebo	40	31	9	19	12	19	21	12	28	0
Maziarz 2020	Midostaurin	30	30	0	NA	NA	28	1	10	20	0
	SOC	30	30	0	NA	NA	27	3	15	15	0
Xuan 2020	Sorafenib	100	100	0	NA	NA	100	0	44	8	48
	SOC	102	102	0	NA	NA	102	0	39	6	57
Gao 2020	Decitabine + GCSF	102	92	8	24	68	100	0	20	5	75
	SOC	102	97	5	29	68	102	0	16	13	73
Oran 2020	Azacitidine	93	55	42	NA	NA	73	14	33	44	4
	SOC	94	45	49	NA	NA	75	18	31	53	5

CHR: complete hematological remission; MRD: minimal residual disease; MAC: myeloablative conditioning; RIC: reduced intensity conditioning; MSD: matched sibling donor; MUD: matched unrelated donor; Haplo: haploidentical donor; SOC: standard of care; GCSF: granulocyte colony stimulating factor.

Figure 2. Overall survival of patients treated with post-transplant maintenance compared to no maintenance. CI: confidence interval; O: observed; E: expected.

Figure 3. Relapse free survival of patients treated with post-transplant maintenance compared to no maintenance. CI: confidence interval; O: observed; E: expected.