Effect of hypomethylating agents on prognosis in acute myeloid leukemia patients treated with HAG priming: a systematic review and meta-analysis

Abstract

ABSTRACT Objectives A combination of hypomethylation agents (HMA) and the HAG regimen (homoharringtonine, cytarabine, G-CSF) shows promise as a treatment for Acute Myeloid Leukemia (AML). Nevertheless, the clinical efficacy of this combined therapy in contrast to the HAG regimen alone remains uncertain. Methods We conducted a meta-analysis of eligible studies comparing the clinical efficacy of these two regimens. A total of 38 studies involving 1195 AML patients were included in the analysis. Results Our findings suggest that the combination of hypomethylation agents (HMAs) and the HAG regimen resulted in a superior clinical response for newly diagnosed (ND) AML but not for relapsed/refractory (R/R) AML when compared to the HAG regimen alone. Subgroup analysis revealed that the pairing of azacitidine with the HAG regimen, as opposed to Decitabine with HAG, exhibited a higher response rate for ND AML when compared to the HAG regimen alone. Additionally, the combination of HMAs and the HAG regimen demonstrated good tolerability with a low early mortality rate and manageable adverse effects. Conclusions Our meta-analysis suggests a potential trend towards improved efficacy when Azacitidine is added to the HAG regimen for treating acute myeloid leukemia (AML), especially in elderly or medically unfit patients. However, these findings should be interpreted as suggestive rather than definitive, emphasizing the need for further studies to confirm these preliminary results.