Intensive Versus Conventional Dose Induction Chemotherapy For Acute Myeloid Leukemia (AML): A Meta-analysis

Objective: To compare the effectiveness of intensive withconventional dose induction chemotherapy for acute myeloid leukemia(AML) with respect to inducing completely remission (CR), preventingearly death (ED) and achieving long time survival.Methods: Combined Medical Subject Heading (MeSH) and keywords to search the databases including Medline, Embase, CochraneLibrary and Cochrane Central Register of Controlled Trials(CENTRAL) and ongoing randomized controlled trails (RCT). UsingReview Manager5.1to do meta-analysis of the13trails and7624patients included. Using modified Jadad scale to do the qualityassessment of the trails included and using funnel plot to estimate thepublication bias of the trails included. The endpoints included CR,overall survival (OS), event-free survival (EFS) and ED rate. Weestimated the heterogeneity of the trails included through·2and I2test with P=0.10. When I2<50%, we adapted fixed-effect model andMantel-Haenszel (M-H) method to do meta-analysis, while adapted random-effect model and M-H method to do meta-analysis whenI2>50%. Finally did subgroup analysis by age of60years old.Results: In the current study,13eligible randomised controlledtrials with7624patients were included. Compared with conventionaldose, induction chemotherapy including intensive dose anthracyclinescould improve CR rate (OR1.35;95%CI1.01to1.81, I2=67%), whilechemotherapy including intensive dose cytarabine could improve theOS (OR1.22;95%CI1.00to1.49, I2=51%) and EFS rate (OR1.23;95%CI1.01to1.49, I2=35%). In the meantime, intensive dosecytarabine could also increase the ED rate (RR1.31;95%CI1.02to1.67, I2=56%). When it refers to the age, intensive dose anthracyclinescould improve both the CR (OR1.80;95%CI1.36to2.38, I2=0%)and OS rate (OR2.18;95%CI1.33to3.56, I2=67%) for patientsyounger than60years old.Conclusion: Induction chemotherapy including intensive doseanthracyclines could improve CR; induction chemotherapy includingintensive dose cytarabine could improve the OS and EFS rate, in themeantime, it also increase the risk of ED; and intensive doseanthracyclines could improve both the CR and OS rate for patientsyounger than60years old.