Meta-analysis of Therapeutic Approaches in Acute Myeloid Leukemia

Objective: To elucidate emerging trends and predictors for optimizing treatment strategies for acute myeloid leukemia (AML). Method: A literature search was conducted on PubMed, Embase, Web of Science, and Google Scholar databases. Bias assessment was conducted using Cochrane’s risk of bias tool, while statistical analyses were performed using Review Manager and Comprehensive Meta-Analysis software. Results: We included 44 studies and the pooled results showed that high-dose cytarabine (HDAC) in induction therapy significantly improved the complete remission (CR) rate than standard-dose cytarabine (SDAC) in younger adults but not older adults (OR: 1.29, 95% CI: 1.12-1.49, P =0.0004 and OR: 1.02, 95% CI: 0.80-1.29, P =0.87, respectively). In consolidation therapy, HDAC showed a significant benefit in event-free survival (EFS) over SDAC (RR: 1.30, 95% CI: 1.04-1.62, P =0.02). The pooled analysis also revealed that idarubicin (IDR) was associated with improved CR rates than daunorubicin (DNR) (OR: 1.34, 95% CI: 1.02-1.76, P =0.04). However, the results do not substantiate the claim that IDR is better than mitoxantrone (MTZ) or that DNR is superior to MTZ in inducing CR (OR: 0.88, 95% CI: 0.72-1.08, P =0.22 and OR: 0.85, 95% CI: 0.72-1.01, P =0.06, respectively). The evidence has also shown that the pooled composite complete response (CRc) rates for FLT3 inhibitors such as sorafenib, gilteritinib, and quizartinib were 56%, 31%, and 36%, respectively. The pooled results further showed that the overall CRc for patients receiving IDH inhibitors and immune checkpoint inhibitors were 49.6% (95% CI: 37-63) and 26% (95% CI: 18.7-35), respectively. Conclusion: Chemotherapy, targeted therapy, and immunotherapy are valuable treatment options for AML patients. However, the efficacy of these AML treatments may vary depending on AML status and patient characteristics such as age and cytogenetic risk.