Long-term effects of hematopoietic growth factors in aplastic anemia patients treated with immunosuppression: Meta-analysis of randomized controlled trials.

Content Provider	Europe PMC
Author	Wang, Anzi Su, Dongyun Luo, Jingyuan Fu, Yuhan Li, Qing Chen, Shu
Copyright Year	2022
Abstract	Background and purpose:Immunosuppressive therapy is the frontline treatment for aplastic anemia patients ineligible for transplantation. The long-term effects of hematopoietic growth factors (HGF) added to standard immunosuppressive therapy are still unclear. We performed a systematic review and meta-analysis to clarify this issue.Methods:A comprehensive search of databases was conducted including 5 international electronic databases (Cochrane, PubMed, Embase, Web of Science, and LILACS) and 4 Chinese electronic databases (Chinese Bio-medicine Database, Chinese National Knowledge Infrastructure, WanFang Data, and China Science and Technology Journal Database databases) from database inception until February, 2022. We included randomized controlled trials that assigned patients with acquired aplastic anemia treated with immunosuppressive therapy (IST), which compared between the addition of HGF and placebo or no treatment. The co-primary outcome were the overall survival (OS) and late clonal malignant evolution at the end of follow-up.Results:Nine randomized controlled trials including 719 participants were identified. The addition of growth factors to immunosuppression yielded no difference in OS (relative risks [RR], 1.08, 95% confidence interval [CI] 0.99–1.18). HGF was not associated with higher occurrence of secondary myelodysplastic syndromes/acute myeloid leukemia (RR, 1.09, 95% CI 0.43–2.78) or paroxysmal nocturnal hemoglobulinemia (RR, 1.38, 95% CI 0.68–2.81) at the end of follow-up. No difference were found in overall response (RR, 1.16, 95% CI 0.98–1.37), infections occurrence (RR, 0.82; 95% CI, 0.51–1.31) or relapse (RR, 0.65; 95% CI, 0.37–1.13).Conclusions:HGF as an adjunct to IST has no impact on long-term OS, late clonal malignant evolution, response rate, relapse or infections occurrence. HGF could be added to standard IST for high-risk patients with delayed neutrophil recovery without concern for long-term consequences but could not be recommended as routine clinical practice.Trial registration number:PROSPERO CRD42021275188.
ISSN	00257974
Journal	Medicine
Volume Number	101
PubMed Central reference number	PMC9592488
Issue Number	42
PubMed reference number	36281138
e-ISSN	15365964
DOI	10.1097/md.0000000000031103
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2022-10-01
Publisher Place	Hagerstown, MD
Access Restriction	Open
Rights License	This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.
Subject Keyword	aplastic anemia hematopoietic growth factors immunosuppressive therapy meta-analysis
Content Type	Text
Resource Type	Article
Subject	Medicine