Comparative efficacy and safety of eleven induction chemotherapy regimens for young adult patients with newly diagnosed acute myeloid leukemia: a network meta-analysis
Comparative efficacy and safety of eleven induction chemotherapy regimens for young adult patients with newly diagnosed acute myeloid leukemia: a network meta-analysis
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十一种诱导化疗方案对新诊断急性髓性白血病年轻成人患者的疗效和安全性比较：网络荟萃分析
DOI：
10.1007/s00277-022-04840-9
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发表时间：
2022-04-20
影响因子：
3.5
通讯作者：
Nie，Danian
中科院分区：
文献类型：
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作者：
Li，Yiqing;Tang，Ting;Nie，Danian
新诊断的急性髓细胞白血病（AML）年轻患者的最佳诱导化疗方案尚未明确，因为缺乏新兴治疗方法之间的直接比较。网络元分析（Network Meta Analysis，NMA）是一种整合直接和间接证据的统计工具，用于评价多种干预措施的效果。因此，我们进行了NMA，以系统地评估这些患者不同诱导的疗效和安全性。检索了PubMed、Embase、科克伦图书馆和Web of Science，检索时间从建立到2020年3月11日。纳入了使用不同诱导方法的随机对照试验（RCT）。我们认为有11项试验符合条件，包括11项诱导试验，共有5052名参与者。计算相对危险度（RR）和95%置信区间（CI）。完全缓解（CR）率以DAC最高，显著高于IA（RR = 1.27，95% CI（1.09-1.48））和DA（RR = 1.28，95% CI（1.13-1.46））（p< 0.05）。DA +吡格列酮的排名仅次于DAC，其次是HAA。早期死亡率HAD、HAA、DA + GO组显著高于DA/IA组（p< 0.05）。与DA/IA相比，DAC和DA +吡格列酮显示相似的早期死亡率（p> 0.05）。关于早期3-4级感染的发生率，未观察到干预措施之间的显著差异。总之，在纳入的11种诱导方案中，DAC可能是新诊断AML的年轻成人患者的首选，具有最高的CR率、较低的早期死亡率和早期感染发生率。DA +吡格列酮和HAA也显示出优于其他方案的CR率，但由于HAA的早期死亡率较高，因此应谨慎使用。
The optimal induction chemotherapy regimens for young adult patients with newly diagnosed acute myeloid leukemia (AML) are not well-defined since the lack of direct comparisons between emerging treatments. Network meta-analysis (NMA) is a statistical tool to integrate direct and indirect evidence to evaluate the effect of multiple interventions. Thus, we conducted an NMA to systematically assess the efficacy and safety of different inductions for these patients. PubMed, Embase, Cochrane Library, and Web of Science were searched from establishment to 2020–03-11. Randomized controlled trials (RCTs) using different inductions were included. We deemed 11 trials eligible, including 11 inductions with 5052 participants. Relative risk (RR) and 95% confidence intervals (CIs) were calculated. In terms of complete remission (CR) rate, DAC ranked highest and was significantly higher than IA (RR = 1.27, 95% CI (1.09–1.48)) and DA (RR = 1.28, 95% CI (1.13–1.46)) (p< 0.05). The ranking of DA + Pioglitazone was second only to that of DAC, followed by HAA. For early mortality, HAD, HAA, and DA + GO were significantly higher than DA/IA (p< 0.05). DAC and DA + Pioglitazone showed similar early mortality compared to DA/IA (p> 0.05). Regarding incidence of early grade 3–4 infection, no significant differences between interventions were observed. To conclude, among the included 11 induction regimens, DAC was potentially the top choice for young adult patients with newly diagnosed AML, with highest CR rate, low early mortality, and incidence of early infection. DA + Pioglitazone and HAA also showed a superiority over the others to achieve higher CR rate, while caution should be kept in mind due to the higher early mortality of HAA.