Thirteen studies of 12 RCTs (n=2,808 patients) were included in the review. Median sample size was 210 patients (range 34 to 840). There were 760 paediatric patients. Where reported, 751 of 1,361 patients received their assigned treatment with autologous stem-cell transplant and 1,087 of 1,341 patients received chemotherapy or no treatment.
There were statistically significant benefits observed for patients treated with autologous stem-cell transplant compared to chemotherapy or no further treatment with a reduced risk of relapse (RR 0.78, 95% CI 0.68 to 0.90, I2=52%; 11 studies) and disease-free survival (HR 0.89, 95% CI 0.80 to 0.98, I2 =26%; 13 studies). Subgroup analyses showed similar findings in adult patients for both outcomes, but the difference was not significant in children. There was evidence of statistical heterogeneity.
There were no significant differences in overall survival between the different treatment groups (11 studies). The findings remained non-significant in adult and paediatric subgroups and there was some evidence of statistical heterogeneity. There were no significant differences in overall survival defined by cytogenic risk categories.
Treatment with autologous stem-cell transplant was associated with a significantly higher risk of treatment-related mortality (RR 1.97, 95% CI 1.39 to 2.80, I2=23%; 11 studies). Subgroup analyses showed similar results in adults, but there were no significant differences in paediatric patients. Some statistical heterogeneity was observed.
Survival from relapse was significantly lower in patients who received autologous stem-cell transplant compared to control groups (HR 2.09, 95% CI 1.41 to 3.08). No statistical heterogeneity was observed for this outcome. Findings were not significantly altered when one study that showed a significant result was removed.
There was no evidence of publication bias for studies that reported disease-free survival and overall survival.