Allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission: systematic review and meta-analysis of prospective clinical trials.
Allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission: systematic review and meta-analysis of prospective clinical trials.
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DOI：
10.1001/jama.2009.813
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发表时间：
2009-06-10
影响因子：
120.7
通讯作者：
Cutler, Corey
中科院分区：
文献类型：
--
作者：
Koreth, John;Schlenk, Richard;Kopecky, Kenneth J.;Honda, Sumihisa;Sierra, Jorge;Djulbegovic, Benjamin J.;Wadleigh, Martha;DeAngelo, Daniel J.;Stone, Richard M.;Sakamaki, Hisashi;Appelbaum, Frederick R.;Doehner, Hartmut;Antin, Joseph H.;Soiffer, Robert J.;Cutler, Corey
急性髓系白血病（AML）首次完全缓解（CR 1）的最佳治疗方法尚不确定。目前的共识，基于细胞遗传学风险，建议清髓性异基因干细胞移植（alloSCT）的低风险，但不是良好的风险AML。认为AlloSCT、自体移植和巩固化疗对中危AML的获益等同。我们对评估alloSCT与非alloSCT治疗AML-CR 1的前瞻性试验进行了系统综述和荟萃分析。量化alloSCT治疗CR 1 AML患者的无复发生存期（RFS）和总生存期（OS）获益。在亚组分析中，确定了alloSCT在良好、中等和低风险AML中的RFS和OS获益。合并搜索词：“同种异体”;“acut*”和“leukem*/leucaem */leucaem */leucaem*/AML”;“myelo*”或“nonlympho”，我们于2009年3月检索了PubMed、Embase和科克伦对照试验注册数据库。共检索到1712篇文章。确定了基于供体可用性分配成人AML-CR 1患者接受alloSCT与非alloSCT治疗的前瞻性试验，并基于意向治疗、供体与非供体报告RFS和/或OS结局。两名评审员独立提取研究特征、干预措施和结局。确定风险比（HR）（95% CI）。分析了24项试验和6，007例患者。研究间异质性不显著。进行了固定效应荟萃分析。AML-CR 1的alloSCT复发或死亡的HR为0.80（0.74-0.86）。alloSCT在低风险（HR 0.69（0.57-0.84））和中风险AML（HR 0.76（0.68-0.85））中记录了显著的RFS获益;但在高风险AML中未记录到（HR 1.06（0.80-1.42））。对于AML-CR 1，alloSCT死亡的HR为0.90（0.82-0.97）。alloSCT在低风险AML（HR 0.73（0.59-0.90））和中风险AML（HR 0.83（0.74-0.93））中记录了显著的OS获益;但在高风险AML中未记录到显著的OS获益（HR 1.07（0.83-1.38））。AlloSCT对中度和低风险AML有显著的RFS和OS获益，但对CR 1中的高风险AML无获益。
The optimal treatment of acute myeloid leukemia (AML) in first complete remission (CR1) is uncertain. Current consensus, based on cytogenetic risk, recommends myeloablative allogeneic stem cell transplantation (alloSCT) for poor-risk but not for good-risk AML. AlloSCT, autologous transplant and consolidation chemotherapy are considered of equivalent benefit for intermediate-risk AML. We undertook a systematic review and meta-analysis of prospective trials evaluating alloSCT versus non-alloSCT therapies for AML-CR1. To quantify relapse-free survival (RFS) and overall survival (OS) benefit of alloSCT for AML in CR1. In subgroup analyses, RFS and OS benefit of alloSCT was determined for good-, intermediate- and poor-risk AML. Combining the search terms: ‘allogeneic’; ‘acut*’ and ‘leukem*/leukaem*/leucem*/leucaem*/aml’; ‘myelo*’ or ‘nonlympho*’, we searched the PubMed, Embase and Cochrane Registry of Controlled Trials databases in March 2009. 1712 articles were accessed. Prospective trials assigning adult AML-CR1 patients to alloSCT versus non-alloSCT treatment(s) based on donor availability, and reporting RFS and/or OS outcomes on intent-to-treat, donor versus no-donor basis were identified. Two reviewers independently extracted study characteristics, interventions, and outcomes. Hazard ratios (HR) (with 95% CI) were determined. 24 trials and 6,007 patients were analyzed. Inter-study heterogeneity was not significant. Fixed effects meta-analysis was performed. HR of relapse or death with alloSCT for AML-CR1 was 0.80 (0.74–0.86). Significant RFS benefit of alloSCT was documented for poor-risk (HR 0.69 (0.57–0.84)) and intermediate-risk AML (HR 0.76 (0.68–0.85)); but not for good-risk AML (HR 1.06 (0.80–1.42)). HR of death with alloSCT for AML-CR1 was 0.90 (0.82–0.97). Significant OS benefit of alloSCT was documented for poor-risk (HR 0.73 (0.59–0.90)) and intermediate-risk AML (HR 0.83 (0.74–0.93)); but not for good-risk AML (HR 1.07 (0.83–1.38)). AlloSCT has significant RFS and OS benefit for intermediate- and for poor-risk AML, but not for good-risk AML in CR1.
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影响因子：
120.7
作者：
Jüni, P;Witschi, A;Egger, M
通讯作者：
Egger, M
影响因子：
6.5
作者：
Keating, S;de Witte, T;Zittoun, RA
通讯作者：
Zittoun, RA
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N
影响因子：
20.3
作者：
Cornelissen, Jan J.;van Putten, Wim L. J.;Lowenberg, Bob
通讯作者：
Lowenberg, Bob
影响因子：
2
作者：
Higgins, JPT;Thompson, SG
通讯作者：
Thompson, SG