Allogeneic Hematopoietic Cell Transplantation Is an Effective Treatment for Blastic Plasmacytoid Dendritic Cell Neoplasm in First Complete Remission: Systematic Review and Meta-analysis.

Abstract

INTRODUCTION:

It is common practice to refer patients to transplantation centers for allogeneic hematopoietic cell transplantation (allo-HCT) for blastic plasmacytoid dendritic-cell neoplasm (BPDCN) despite lack of randomized controlled trials. We performed a systematic review to assess the totality of evidence pertaining to the efficacy of allo-HCT in BPDCN.

METHODS:

We searched the Cochrane, PubMed, and Embase databases through January 5, 2018, for studies on allo-HCT for BPDCN. Two authors independently reviewed all references for inclusion and extracted data related to benefits (overall [OS] and progression-free/disease-free [PFS/DFS] survival) and harms (relapse and nonrelapse mortality) from included studies. When appropriate, data were pooled using random-effects model.

RESULTS:

Four studies (128 patients) were included in analysis. Pooled OS rate was 50% (95% confidence interval [CI], 41-59) for all patients. Among patients who underwent allografting whose disease was in first complete remission (CR1), pooled OS and PFS/DFS rates were 67% (95% CI, 52-80) and 53% (95% CI, 29-76), respectively. For patients who underwent allografting in > CR1, pooled OS and PFS/DFS rates were 7% (95% CI, 0-32) for both outcomes. Relapse rates were higher when reduced-intensity regimens were used (40% [95% CI, 25-56] vs. 18% [95% CI, 7-31]).

CONCLUSION:

This systematic review represents the best available evidence supporting allo-HCT in BPDCN, especially when offered in CR1. Use of myeloablative allo-HCT results in lower pooled relapse rates (18% vs. 40%). A prospective comparative study will be needed to determine the impact of intensity of the conditioning regimen on postallograft relapse.

• Authors: Mohamed A Kharfan-Dabaja, Tea Reljic, Hemant S Murthy, Ernesto Ayala, Ambuj Kumar
• Journal: Clinical lymphoma, myeloma & leukemia (Clin Lymphoma Myeloma Leuk) Vol. 18 Issue 11 Pg. 703-709.e1 (11 2018) ISSN: 2152-2669 [Electronic] United States
• PMID: 30145196 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: Copyright © 2018 Elsevier Inc. All rights reserved.

Topics

• Blast Crisis (pathology, therapy)
• Dendritic Cells (pathology)
• Hematologic Neoplasms (pathology, therapy)
• Hematopoietic Stem Cell Transplantation
• Humans
• Remission Induction
• Transplantation, Homologous
• Treatment Outcome