Benefits and risks of haematopoietic stem cell transplantation for systemic sclerosis: A systematic review and meta-analysis
Benefits and risks of haematopoietic stem cell transplantation for systemic sclerosis: A systematic review and meta-analysis
复制标题
造血干细胞移植治疗系统性硬化症的益处和风险：系统评价和荟萃分析
DOI：
10.1093/mr/roac026
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发表时间：
2022
影响因子：
2.2
通讯作者：
Nakajima Hideaki
中科院分区：
文献类型：
--
作者：
Higashitani Kana;Takase-Minegishi Kaoru;Yoshimi Ryusuke;Kirino Yohei;Hamada Naoki;Nagai Hideto;Hagihara Maki;Matsumoto Kenji;Namkoong Ho;Horita Nobuyuki;Nakajima Hideaki
目的评价造血干细胞移植（HSCT）治疗系统性硬化症（systemicsclerosis）的疗效和安全性。我们使用Kaplan-Meier方法和患者水平数据比较了HSCT和静脉冲击环磷酰胺之间的生存结局。此外，与HSCT的治疗相关的死亡的发病率汇总使用随机效应model.ResultsOf筛选的2091篇文章，包括22：3个随机对照试验和19个观察性研究。HSCT研究显示皮肤厚度评分和肺功能显著改善。尽管HSCT的治疗相关死亡率高于静脉冲击环磷酰胺，但Kaplan-Meier分析显示移植后2年的生存率较高（对数秩，P= 0.004）。700例系统性硬化症患者移植相关死亡的合并频率为6.30%（95%置信区间4.21-8.38）。然而，估计频率的治疗相关的死亡一直在减少在过去的decades.ConclusionsHSCT是一种有效的治疗系统性硬化症，但最佳适应症必须仔细确定平衡的风险。
ObjectivesWe aimed to evaluate the efficacy and safety of haematopoietic stem cell transplantation (HSCT) in patients with systemic sclerosis.MethodsA systematic literature review and meta-analysis were carried out. We compared survival outcomes using the Kaplan–Meier method with patient-level data between HSCT and intravenous pulse cyclophosphamide. Additionally, the incidence rate of treatment-related deaths with HSCT was pooled using a random-effect model.ResultsOf the 2091 articles screened, 22 were included: 3 randomized controlled trials and 19 observational studies. HSCT studies showed significant improvement in the skin thickness score and lung function. Despite treatment-related deaths being higher in HSCT than in intravenous pulse cyclophosphamide, the Kaplan–Meier analysis showed a high survival rate of 2 years post-transplant (log-rank,P= 0.004). The pooled frequency of transplant-related death from 700 systemic sclerosis patients was 6.30% (95% confidence interval 4.21–8.38). However, the estimated frequency of treatment-related deaths has been reducing over the last decade.ConclusionsHSCT is an effective treatment for systemic sclerosis, but the optimal indications must be carefully determined by balancing the risks.