Chemotherapeutic Options in Chronic Lymphocytic Leukemia: a Meta-analysis of the Randomized Trials

Chemotherapeutic Options in Chronic Lymphocytic Leukemia: a Meta-analysis of the Randomized Trials
复制标题

慢性淋巴细胞白血病的化疗选择：随机试验的荟萃分析

DOI：
--
复制
发表时间：
1999
期刊：
影响因子：
--
通讯作者：
Grp Clltc.
Grp Clltc.
中科院分区：
--
文献类型：
--
作者：
C. Geisler;M. Hansen;B. Yeap;P. Wiernik;J. Binet;C. Chastang;G. Dighiero;P. Travade;B. Jakšić;M. Brugiatelli;E. Kimby;D. Catovsky;T. Hamblin;S. Richards;F. Bosch;M. Fontanillas;E. Montserrat;R. Alison;M. Clarke;H. Duong;P. Elphinstone;V. Evans;J. Godwin;R. Gray;E. Greaves;C. Hicks;S. James;G. Mead;R. Peto;K. Wheatley;Grp Clltc.

文献摘要

参考文献

被引文献

相似文献

背景：评估慢性淋巴细胞白血病（CLL）初始化疗时间和强度的随机试验通常规模太小，无法单独提供可靠的结果。我们比较了以下对生存的影响：a)早期CLL的即时化疗与延迟化疗；b)联合化疗（例如，环磷酰胺和长春新碱加强的松/泼尼松[COP]或COP加阿霉素[CHOP]）与单药氯霉素作为更晚期疾病的一线治疗。方法：对所有相关的随机试验，无论是否已发表，进行联合荟萃分析，对每位患者的数据进行集中评价。结果：在6项试验中，有2048例早期疾病患者接受了立即化疗和延期化疗（氯苯或氯苯加强的松/泼尼松）。立即化疗的10年生存率略差（但没有统计学上的显著差异）（44% vs 47%生存率；差异= -3%；95%可信区间[CI] = -10% ~ 4%）。另有2022名患者参与了10项联合化疗与氯霉素的试验，联合或不联合强的松/泼尼松龙。两例患者的5年生存率均为48%（差异= 0%;95% CI = -6% ~ 5%）。这10个试验中有6个亚组涉及含有蒽环类药物的方案，但总生存率同样不优于使用氯霉素的方案（基于蒽环类药物的方案：627例患者中有325例死亡；使用氯霉素的方案：636例患者中有306例死亡；死亡率比= 1.07;95% CI = 0.91-1.25；无统计学意义）。结论：就生存期而言，这些试验支持CLL的保守治疗策略，即对大多数早期疾病患者不进行化疗，并将单药氯霉素作为大多数晚期疾病患者的一线治疗，没有证据表明早期纳入蒽环类药物有益。然而，当其他药物的试验获得成熟结果时，需要重新考虑这一策略。
BACKGROUND: The randomized trials that evaluate the timing and intensity of initial chemotherapy for chronic lymphocytic leukemia (CLL) have, in general, been too small to provide separately reliable results. We compared the effects on survival of the following: a) immediate versus deferred chemotherapy for early-stage CLL and b) combination chemotherapy (e.g., cyclophosphamide and vincristine plus prednisone/prednisolone [COP] or COP plus doxorubicin [CHOP]) versus single-agent chlorambucil as first-line treatment for more advanced disease. METHODS: All relevant randomized trials, whether published or not, were sought for a collaborative meta-analysis involving centralized review of the data for each patient. RESULTS: There were 2048 patients with early disease in six trials of immediate versus deferred chemotherapy (chlorambucil or chlorambucil plus prednisone/prednisolone). The 10-year survival was slightly worse (but not statistically significantly so) with immediate chemotherapy (44% versus 47% survival; difference = -3%; 95% confidence interval [CI] = -10% to 4%). There were another 2022 patients in 10 trials of combination chemotherapy versus chlorambucil, with or without prednisone/prednisolone. The 5-year survival was 48% in both cases (difference = 0%; 95% CI = -6% to 5%). A subgroup of six of these 10 trials involved an anthracycline-containing regimen but again overall survival appeared no better than with chlorambucil (anthracycline-based regimen: 325 deaths among 627 patients; chlorambucil: 306 deaths among 636 patients; death rate ratio = 1.07; 95% CI = 0.91-1.25; not statistically significant). CONCLUSIONS: In terms of survival, these trials support a conservative treatment strategy for CLL, i.e., no chemotherapy for most patients with early-stage disease, and single-agent chlorambucil as the first line of treatment for most patients with advanced disease, with no evidence of benefit from early inclusion of an anthracycline. This strategy will, however, need to be reconsidered as mature results become available from trials of other agents. Lijec Vjesn 1997 Nov-Dec;119(11-12):328-30 [Case report of a female patient with autoimmune hemolytic anemia and cold agglutinin antibodies]. [Article in Serbo-Croatian (Roman)] Konja, Josip; Jakovljevic, G.; Jaksic, Branimir; Grgicevic, Damir; Car, M.; Glavas, B.: We report a case of acute transient cold agglutinin disease, the etiology of which we could not determine with the available methods. Cold autoagglutinins had anti I specificity, high titers of the autoantibody (> 1:1,000) and the thermal range was relative wide. Our patient had severe haemolysis and immunosuppressive therapy with methylprednisolone and cyclophosphamide was administered. It is a question how much these immunosuppresive agents influenced the recovery, and in what extent it was a self limited disease with spontaneous recovery.
Comparison of chlorambucil and prednisone versus cyclophosphamide, vincristine, and prednisone as initial treatment for chronic lymphocytic leukemia: long-term follow-up of an Eastern Cooperative Oncology Group randomized clinical trial.
DOI： 10.1200/jco.1991.9.5.770
发表时间： 1991-05
期刊： Journal of clinical oncology : official journal of the American Society of Clinical Oncology
影响因子： --
作者：
B. Raphael;Janet Andersen;R. Silber;Martin M. Oken;D. Moore;J. Bennett;H. Bonner;Richard G. Hahn;W. Knospe;Joseph J. Mazza
通讯作者： B. Raphael;Janet Andersen;R. Silber;Martin M. Oken;D. Moore;J. Bennett;H. Bonner;Richard G. Hahn;W. Knospe;Joseph J. Mazza