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Comparison of early mortality between leukapheresis and non-leukapheresis in adult acute myeloid leukemia patients with hyperleukocytosis: a systematic review and meta-analysis
Rinaldi I, Sutandyo N, Winston K
Hematology (Amsterdam, Netherlands). 2022;27(1):141-149
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Abstract
OBJECTIVES One of the treatment modalities that can be used for hyperleukocytosis is leukapheresis. However, the result of studies showing the benefit of early mortality through the use of leukapheresis versus no leukapheresis is still inconclusive. Hence, we aimed to conduct a systematic review with meta-analysis to determine the effect of leukapheresis on early mortality in AML patients with hyperleukocytosis. METHODS We conducted a literature search on five databases (PubMed, EBSCOhost, Scopus, Clinicalkey, and JSTOR) up to October 2021 for studies comparing early mortality outcomes between hyperleukocytosis AML patients treated with leukapheresis versus no leukapheresis. Summary odds ratios (OR) and 95% confidence intervals (CI) were calculated using random-effects models. Heterogeneity tests were presented in I(2) value and publication bias was analyzed using a funnel plot. RESULTS Eleven retrospective cohort studies were eligible based on the inclusion and exclusion criteria. Pooled analysis showed that there was no significant difference in early mortality between patients receiving leukapheresis and not receiving leukapheresis in studies using hyperleukocytosis cutoff of 95,000/mm(3) or 100,000/mm(3) (OR: 1.17; 95% CI: 0.74-1.86; p: 0.50; I(2): 0%). Similarly, studies using hyperleukocytosis cutoff of 50,000/mm(3) also showed no benefits of early mortality (OR: 0.67; 95% CI: 0.43-1.05; p: 0.08; I(2): 0%). Most of the studies used had a moderate risk of bias due to being observational studies. Funnel plot showed an indication of publication bias on studies using hyperleukocytosis cutoff of ≥50,000/mm(3). CONCLUSION The use of leukapheresis does not provide early mortality benefit in adult AML patients with hyperleukocytosis.
PICO Summary
Population
Adult acute myeloid leukemia patients (11 studies, n= 1,407).
Intervention
Leukapheresis intervention (n= 1,090).
Comparison
Not receiving leukapheresis (n= 317).
Outcome
Pooled analysis showed that there was no significant difference in early mortality between patients receiving leukapheresis and not receiving leukapheresis in studies using hyperleukocytosis cutoff of 95,000/mm3 or 100,000/mm3. Studies using hyperleukocytosis cutoff of 50,000/mm3 showed no benefits of early mortality.
2.
Multiple myeloma management in COVID-19 era
Kurniawan A, Halim DA, Sutandyo N
Asian Journal of Oncology. 2020
Abstract
Introduction Coronavirus disease 2019 (COVID-19) has become a world pandemic since early 2020 The complexity of handling multiple myeloma (MM) has increased substantially during this pandemic The objective of this review is to know the current recommendation to manage MM in the COVID-19 era Methods Electronic databases, including PubMed central and PubMed, were used to conduct a literature search It was conducted on May 18, 2020, using the keywords multiple myeloma AND COVID-19 AND Prevalence OR Impact OR treatment OR prophylactic The included articles were review articles, recommendations, case reports or series, or population-based studies (cross-sectional, cohort, case-control, or interventional), and full-text if available Results A total of 124 articles were identified through the search strategy The two reviewers screened titles and abstracts of all articles Most articles were excluded because of ineligible to the criteria Ultimately, 18 articles were included in the final evaluation MM patients might have higher risk to become severe COVID-19 if they got infected due to their immunocompromised condition Due to the pandemic, precise treatment priorities should be made by considering its benefit and the risk of MM progression For the young, especially healthy patients, the most effective therapy should be offered and tailored to the patient's goal Several MM societies have published the recommendation regarding the special stage of MM Conclusion Myeloma societies in the world have released recommendations related to the management of myeloma patients However, there is scarce of evidence to do the recommendation