Tandem Versus Single Autologous Hematopoietic Cell Transplantation for the Treatment of Multiple Myeloma: A Systematic Review and Meta-analysis
Tandem Versus Single Autologous Hematopoietic Cell Transplantation for the Treatment of Multiple Myeloma: A Systematic Review and Meta-analysis
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DOI：
10.1093/jnci/djn439
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发表时间：
2009-01-21
影响因子：
10.3
通讯作者：
Djulbegovic, Benjamin
中科院分区：
文献类型：
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作者：
Kumar, Ambuj;Kharfan-Dabaja, Mohamed A.;Djulbegovic, Benjamin
在多发性骨髓瘤(MM)患者中，串联式自体造血移植(AHCT)和单一AHCT的疗效有相互矛盾的证据。我们进行了一项系统的综述和荟萃分析，以综合现有证据与联合AHCT治疗MM患者的有效性相关。我们搜索Medline、会议记录和检索文章的书目，并联系该领域的专家，以确定以任何语言报道的随机对照试验(RCT)，这些试验在2008年3月31日之前在MM患者中与单一AHCT治疗进行比较。终点为总存活率(OS)、无事件存活率(EFS)、有效率和治疗相关死亡率(TRM)。数据在随机效应模型下汇集。6个随机对照试验招募了1803名患者，符合纳入标准。接受串联AHCT治疗的患者没有更好的OS(串联移植与单一移植的死亡率风险比[HR]=0.94；95%可信区间[CI]=0.77~1.14)或EFS(HR=0.86；95%CI=0.70~1.05)。串联AHCT的有效率显著高于串联AHCT(Risk Ratio=0.79，95%CI=0.67~0.93)，而TRM组的有效率显著增加(Risk Ratio=1.71，95%CI=1.05~2.79)。在未经治疗的多发性骨髓瘤患者中，串联AHCT的使用并不能改善OS或EFS。我们的结论是，串联AHCT与改善的应答率有关，但存在临床上TRM显着增加的风险。
Evidence bearing on the efficacy of tandem autologous hematopoietic transplant (AHCT) vs a single AHCT in patients with multiple myeloma (MM) is conflicting. We performed a systematic review and meta-analysis to synthesize the existing evidence related to the effectiveness of tandem vs single AHCT in patients with MM.We searched Medline, conference proceedings, and bibliographies of retrieved articles and contacted experts in the field to identify randomized controlled trials (RCTs) reported in any language that compared tandem with single AHCT in patients with MM through March 31, 2008. Endpoints were overall survival (OS), event-free survival (EFS), response rate, and treatment-related mortality (TRM). Data were pooled under a random-effects model.Six RCTs enrolling 1803 patients met the inclusion criteria. Patients treated with tandem AHCT did not have better OS (hazard ratio [HR] for mortality for patients treated with tandem transplant vs single transplant = 0.94; 95% confidence interval [CI] = 0.77 to 1.14) or EFS (HR = 0.86; 95% CI = 0.70 to 1.05). Response rate was statistically significantly better with tandem AHCT (risk ratio = 0.79, 95% CI = 0.67 to 0.93), but with a statistically significant increase in TRM (risk ratio = 1.71, 95% CI = 1.05 to 2.79). There was statistically significant heterogeneity among RCTs for OS and EFS.In previously untreated MM patients, use of tandem AHCT did not result in improved OS or EFS. We conclude that tandem AHCT is associated with improved response rates but at risk of clinically significant increase in TRM.