Conventional and high-dose daunorubicin and idarubicin in acute myeloid leukaemia remission induction treatment: a mixed treatment comparison meta-analysis of 7258 patients
Conventional and high-dose daunorubicin and idarubicin in acute myeloid leukaemia remission induction treatment: a mixed treatment comparison meta-analysis of 7258 patients
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DOI：
10.1002/hon.2173
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发表时间：
2015-12-01
影响因子：
3.3
通讯作者：
Ribeiro, Rodrigo Antonini
中科院分区：
文献类型：
--
作者：
Sekine, Leo;Morais, Vinicius Daudt;Ribeiro, Rodrigo Antonini
先前的荟萃分析表明，含有伊达比星（IDA）或高剂量柔红霉素（HDD）的急性髓性白血病诱导方案诱导的完全缓解（CR）率高于常规剂量柔红霉素（CDD），可能有利于总生存期。然而，这些方案之间的可靠比较仍然缺乏。我们对这三种方案进行了混合治疗比较荟萃分析。混合治疗比较是一种数据汇总的统计方法，它汇总了来自直接和间接效应估计的数据。文献检索策略包括MEDLINE、EMBASE、科克伦、Scielo和LILACS，从开始到2013年8月，结果纳入了17项试验，共入组7258例成人患者。HDD [相对危险度（RR）1.13; 95%可信区间（CrI）1.02-1.26]和IDA（RR 1.13; 95% CrI 1.05-1.23）的CR率高于CDD。与CDD相比，IDA还导致较低的长期总体死亡率（RR 0.93，95%CrI 0.86-0.99），而HDD和CDD没有差异（RR 0.94，95%CrI 0.85-1.02）。HDD和IDA比较在CR（RR 1.00; 95%CrI 0.89-1.11）和长期死亡率（RR 1.01，95%CrI 0.91-1.11）方面没有达到统计学显著差异。IDA和HDD在诱导CR方面始终上级CDD，IDA与较低的长期死亡率相关。基于这些发现，我们建议将IDA和HDD而不是传统的CDD作为急性髓系白血病诱导的标准治疗。在这项研究中，与CDD相比，HDD对死亡率缺乏益处，应谨慎处理，因为由于统计功效的限制，它可能容易被低估。版权所有（C）2014约翰威利父子有限公司
Previous meta-analyses suggested that acute myeloid leukaemia induction regimens containing idarubicin (IDA) or high-dose daunorubicin (HDD) induce higher rates of complete remission (CR) than conventional-dose daunorubicin (CDD), with a possible benefit in overall survival. However, robust comparisons between these regimens are still lacking. We conducted a mixed treatment comparison meta-analysis regarding these three regimens. Mixed treatment comparison is a statistical method of data summarization that aggregates data from both direct and indirect effect estimates. Literature search strategy included MEDLINE, EMBASE, Cochrane, Scielo and LILACS, from inception until August 2013 and resulted in the inclusion of 17 trials enrolling 7258 adult patients. HDD [relative risk (RR) 1.13; 95% credible interval (CrI) 1.02-1.26] and IDA (RR 1.13; 95% CrI 1.05-1.23) showed higher CR rates than CDD. IDA also led to lower long-term overall mortality rates when compared with CDD (RR 0.93, 95% CrI 0.86-0.99), whereas HDD and CDD were no different (RR 0.94, 95% CrI 0.85-1.02). HDD and IDA comparison did not reach statistically significant differences in CR (RR 1.00; 95% CrI 0.89-1.11) and in long-term mortality (RR 1.01, 95% CrI 0.91-1.11). IDA and HDD are consistently superior to CDD in inducing CR, and IDA was associated with lower long-term mortality. On the basis of these findings, we recommend incorporation of IDA and HDD instead of the traditional CDD as standard treatments for acute myeloid leukaemia induction. The lack of HDD benefit on mortality, when compared with CDD in this study, should be cautiously addressed, because it may have been susceptible to underestimation because of statistical power limitations. Copyright (C) 2014 John Wiley & Sons, Ltd.