Efficacy and safety of autologous hematopoietic stem cell transplantation in the treatment of malignant lymphoma after chemotherapy: a systematic review and meta-analysis

BACKGROUND: Autologous hematopoietic stem cell transplantation (AHSCT) is a common method for the clinical treatment of malignant lymphomas that recur after conventional chemotherapy. It has been reported that its efficacy is better than conventional chemotherapy, but the efficacy of its first-line treatment is controversial, and the existing clinical randomized controlled trials have not yet reached a unified conclusion. This work intended to use meta-analysis to systematically evaluate the efficacy and safety of AHSCT in the treatment of malignant lymphoma after high-dose chemotherapy, and draw reliable conclusions to provide reference and basis for clinical application. METHODS: The inclusion and exclusion criteria were formulated based on the PICOIS principle. Relevant articles were retrieved from Medline, Excerpta Medica Database (EMBASE), Elton B. Stephens. Company (EBSCO), Ovid Technologies (OVID), China Biomedical Database, and Wanfang. The search period was limited the study published between January 1, 1980 and November 2021. The search terms included malignant lymphoma, autologous hematopoietic stem cell transplantation, AHSCT, high-dose chemotherapy, etc. The study subjects were diagnosed as malignant lymphoma patients. The experimental group was defined as AHSCT after high-dose chemotherapy, and the control group was defined as conventional chemotherapy (the chemotherapy regimen was not limited). The outcome indicators were overall survival (OS), complete remission rate [complete response (CR) + partial response (PR)], and event-free survival (EFS). RevMan5.3 software provided by the Cochrane Collaboration was used for meta-analysis. RESULTS: A total of 6 pieces of literature were included, with 264 cases in the experimental group and 389 cases in the control group. There was no risk of bias in the included literature. The intervention method in the control group was conventional chemotherapy (chemotherapy regimen was not limited). The differences in the rates of overall survival and progression-free survival between the groups were compared, and it was found that the overall survival between groups was [odds ratio (OR) =2.88; 95% confidence interval (CI): 1.78–4.66; Z=4.31; P<0.0001] and progression-free survival rate was (OR =2.70; 95% CI: 1.86–3.92, Z=5.21; P<0.00001). DISCUSSION: AHSCT treatment can significantly prolong the overall survival and progression-free survival rates of patients with malignant lymphoma after chemotherapy.