Defibrotide for the prevention of hepatic veno‐occlusive disease after hematopoietic stem cell transplantation: a systematic review
Defibrotide for the prevention of hepatic veno‐occlusive disease after hematopoietic stem cell transplantation: a systematic review
复制标题
去纤苷预防造血干细胞移植后肝静脉闭塞性疾病：系统评价
作者：
Li;Yebo Wang;He Huang
预防性使用去纤维蛋白肽（DF）预防静脉闭塞性疾病（VOD），这是造血干细胞移植（HSCT）相对常见和高风险的并发症，可能是降低VOD发病率和死亡率的一种令人鼓舞的方式。然而，结论仍不明确。我们进行了系统的回顾，以总结知识的状态。检索到1项随机对照试验（RCT）、4项队列研究和8项病例系列研究，共纳入1230例患者。使用DF的患者中VOD的总体平均发生率为4.7%（95% CI，3.3-6.1），显著低于135项未使用VOD预防的研究中的数据13.7%（95% CI，13.3-14.1）（p < 0.005）。对照试验中VOD发生率的Meta分析显示，DF组VOD发生率在统计学上降低（RR = 0.47，95% CI，0.31-0.73）。重度VOD的总体平均发生率为0.8%（95% CI，0.2-1.4）。RR为0.31（95%CI，0.09-1.06）。然而，缺乏随机对照试验和研究的方法学缺陷可能会妨碍得出可推广的结论。我们的综述描述了DF在VOD预防方面的前景，需要进行大规模的RCT进一步证实。
Prophylactic use of defibrotide (DF) to prevent veno‐occlusive disease (VOD), a relatively common and high‐risk complication of hematopoietic stem cell transplantation (HSCT), may be an encouraging modality to reduce morbidity and mortality from VOD. However, conclusions remain unclear. We carried out a systematic review to summarize the state of knowledge. One randomized controlled trial (RCT), four cohort studies and eight case series studies were found, including a total of 1230 patients. The overall mean incidence of VOD in patients using DF was 4.7% (95% CI, 3.3–6.1) which was significantly lower than the data 13.7% (95% CI, 13.3–14.1) across 135 studies using no VOD prophylaxis (p < 0.005). The meta‐analysis of the incidence of VOD in controlled trials revealed a statistical reduction in VOD incidence in the DF group (RR = 0.47, 95% CI, 0.31–0.73). The overall mean incidence of severe VOD was 0.8% (95% CI, 0.2–1.4). The RR was 0.31 (95% CI, 0.09–1.06). However, the lack of RCTs and the methodological weaknesses of the studies may preclude making generalizable conclusions. Our review described that DF appears promising for VOD prevention and large RCT is needed for further confirmation.
影响因子：
20.3
作者：
Bearman, SI;Lee, JL;McDonald, GB
通讯作者：
McDonald, GB
影响因子：
20.3
作者：
P. Richardson;A. Elias;A. Krishnan;C. Wheeler;R. Nath;D. Hoppensteadt;Nancy M. Kinchla;D. Neuberg;E. Waller;J. Antin;R. Soiffer;J. Vredenburgh;M. Lill;A. Woolfrey;S. Bearman;M. Iacobelli;J. Fareed;E. Guinan
通讯作者：
P. Richardson;A. Elias;A. Krishnan;C. Wheeler;R. Nath;D. Hoppensteadt;Nancy M. Kinchla;D. Neuberg;E. Waller;J. Antin;R. Soiffer;J. Vredenburgh;M. Lill;A. Woolfrey;S. Bearman;M. Iacobelli;J. Fareed;E. Guinan
影响因子：
4.3
作者：
Coppell, Jason A.;Richardson, Paul G.;Soiffer, Robert;Martin, Paul L.;Kernan, Nancy A.;Chen, Allen;Guinan, Eva;Vogelsang, Georgia;Krishnan, Amrita;Giralt, Sergio;Revta, Carolyn;Carreau, Nicole A.;Iacobelli, Massimo;Carreras, Enric;Ruutu, Tapani;Barbui, Tiziano;Antin, Joseph H.;Niederwieser, Dietger
通讯作者：
Niederwieser, Dietger