SYSTEMATIC REVIEW article
Front. Oncol.
Sec. Hematologic Malignancies
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1627825
Comparing therapeutic effects of hematopoietic stem cell transplantation, tyrosine kinase inhibitors and chemotherapy in adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia: A systematic review and meta-analysis
Provisionally accepted
- 1Other
- 2The Affiliated Hospital of Jiaxing University, Jiaxing, China
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Objective: Both hematopoietic stem cell transplantation (HSCT) and chemotherapy combined with tyrosine kinase inhibitors (TKIs) have shown therapeutic efficacy in patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL). This study aimed to compare the clinical outcomes of HSCT and TKI-combined chemotherapy regimens in Ph+ ALL through a meta-analysis. Methods: We systematically searched PubMed (from 1966), Embase (from 1974), and the Cochrane Library (from 1993) up to April 30, 2025, for eligible studies. Overall survival (OS) and disease-free survival (DFS) were evaluated using hazard ratios (HRs) with 95% confidence intervals (CIs), while relapse risk was assessed using odds ratios (ORs) with 95%CIs. A random-effects model was applied for all analyses. Results: The meta-analysis included 35 studies involving 3,827 patients with Ph+ ALL. Allogeneic HSCT (allo-HSCT) was associated with significantly better OS (HR: 0.60; 95% CI: 0.45–0.81; P = 0.001) and DFS (HR: 0.40; 95% CI: 0.30–0.54; P < 0.001) compared to TKI-based chemotherapy. No significant differences in OS (HR: 0.97; 95% CI: 0.70–1.34; P = 0.845) or DFS (HR: 0.92; 95% CI: 0.67–1.26; P = 0.605) were observed between allo-HSCT and autologous HSCT (auto-HSCT). Moreover, allo-HSCT was associated with a significantly lower relapse risk than both TKI-based chemotherapy (OR: 0.28; 95% CI: 0.16–0.51; P < 0.001) and auto-HSCT (OR: 0.39; 95% CI: 0.27–0.54; P < 0.001). Conclusion: This meta-analysis demonstrates that allo-HSCT provides superior survival outcomes compared to TKI-based chemotherapy in patients with Ph+ ALL. Although survival outcomes are similar between allo-HSCT and auto-HSCT, allo-HSCT is associated with a significantly reduced risk of relapse.
Keywords: Philadelphia chromosome-positive, Acute Lymphoblastic Leukemia, tyrosine kinase inhibitor, Hematopoietic Stem Cell Transplantation, Meta-analysis
Received: 13 May 2025; Accepted: 29 Sep 2025.
Copyright: © 2025 Gao, Zeng, Sun, Zhao, Wu, Yan, Li, Fu and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Gang Zhang, 921950782@qq.com
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