Comparing Allogeneic vs. Autologous Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia - Evaluating Outcomes Across Age Groups: A Systematic Review

Background Acute myeloid leukaemia (AML) impacts various age groups, with hematopoietic stem cell transplantation (HSCT) being an important treatment option, this review compares the outcomes of allogeneic and autologous HSCT, focusing on the influencing factors across different age demographics. Methods A comprehensive literature search was conducted across five databases, including PubMed/Medline, Cochrane Library, ScienceDirect, Europe PMC, EBSCO, and ClinicalTrials.gov. The inclusion criteria encompassed randomized controlled trials (RCTs), non-randomized controlled trials, cohort studies, and case-control studies published since inception. After screening, 19 studies were selected for review, all demonstrating moderate to high quality. Results A total of 21,977 participants were included across the 19 studies, the majority of which were observational. Key outcomes assessed post-transplantation included overall survival (OS), disease-free survival (DFS), relapse rates, transplant-related mortality (TRM), and relapse-free survival (RFS). Notably, patients with abnormal 17p chromosomes exhibited varying OS based on age, with those under 50 showing better outcomes. An RCT indicated that autologous HSCT resulted in lower TRM and improved OS for children and adolescents, albeit with higher relapse rates compared to allogeneic HSCT. In elderly populations, autologous HSCT showed no significant difference in OS but demonstrated lower non-relapse mortality (NRM) compared to allogeneic HSCT. Conclusion Various factors influence HSCT outcomes in AML patients. Autologous HSCT may yield better results for children and adolescents, while allogeneic HSCT appears more effective for adults and the elderly concerning survival and relapse rates, despite some studies indicating a mortality advantage for autologous HSCT.