Evaluation of Efficacy, Safety, and Prognostic Value of Induction Chemotherapy in Patients with Acute Myeloid Leukemia: An Updated Meta-Analysis of a 5-Year Study

I Made Adi  Narendranatha Komara; Ketut Suega; NI Made Renny  Anggreni Rena; I Wayan Losen Adnyana

doi:10.18502/ijhoscr.v19i3.19288

I Made Adi Narendranatha Komara Department of Internal Medicine, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital Denpasar,Bali, Indonesia
Ketut Suega Medical Hemato-Oncology Division, Department of Internal Medicine, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
NI Made Renny Anggreni Rena Medical Hemato-Oncology Division, Department of Internal Medicine, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
I Wayan Losen Adnyana Medical Hemato-Oncology Division, Department of Internal Medicine, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia

DOI: https://doi.org/10.18502/ijhoscr.v19i3.19288

Keywords: Acute myeloid leukemia (AML); Efficacy; Induction chemotherapy; Prognosis

Abstract

Acute Myeloid Leukemia (AML) is a type of cancer that affects the bone marrow and blood. This study aims to conduct a five-year update on induction chemotherapy's efficacy, safety, and prognostic value in patients with AML.

Based on the PRISMA 2020 guidelines, a systematic search was performed on online databases for relevant studies on complete remission with incomplete hematologic response (CRi), complete remission (CR), adverse events, and overall survival. The articles obtained were observational studies that met the inclusion and exclusion criteria. The quality of the studies was assessed using the Revised Cochrane’s risk-of-bias tool. The analysis was conducted using Review Manager 5.4 and R Statistical Software 3.3.

Thirteen clinical trial studies, involving 1,863 participants, were included in this survey. Based on the analysis, the CRi and CR levels, where each was obtained as a whole at 9% (random effect; 95%CI 6-13%; heterogeneity;

t 2 <0.01; I2=88%). Gastrointestinal side effects, hepatotoxicity, nephrotoxicity, cardiotoxicity, and infection after induction chemotherapy in AML patients overall were 22% (random effect; 95%CI 10-44%; heterogeneity; t 2<0.01; I 2=89%), 8% (random effect; 95%CI 5-11%; heterogeneity; t 2=0.62; I2=0%), 15% (random effect; 95%CI 4-44%; heterogeneity; t 2 <0.01; I2=89%), 7% (random effect; 95%CI 5 – 11%; heterogeneity; t 2<0.01; I 2=76%), and 20% (random effect; 95%CI 13-30%; heterogeneity; t 2<0.01; I2=76%). Overall survival was 57% (random effect; 95%CI 43-71%; heterogeneity; t 2<0.01; I2=86%). Peter’s test showed a significant risk of publication bias. Induction chemotherapy is effective and improves outcomes in AML patients.