Determinants of the optimal first-line therapy for follicular lymphoma: a decision analysis.
Determinants of the optimal first-line therapy for follicular lymphoma: a decision analysis.
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滤泡性淋巴瘤最佳一线治疗的决定因素：决策分析。
DOI：
10.1002/ajh.21655
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发表时间：
2010
影响因子：
12.8
通讯作者：
Andreadis,Charalambos
中科院分区：
文献类型：
--
作者：
Olin,RebeccaL;Kanetsky,PeterA;TenHave,ThomasR;Nasta,SunitaD;Schuster,StephenJ;Andreadis,Charalambos
联合免疫化疗是晚期滤泡性淋巴瘤患者初始治疗的最常见方法，但对于可用方案的最佳选择或顺序尚未达成共识。我们进行了这项决策分析，以系统地评估影响该疾病患者早期治疗选择的参数。我们设计了一个马尔可夫模型，将三种最常用的治疗方案（RCVP、RCHOP 和 RFlu）与一线和二线疗法相结合，终点为疾病进展之前的质量调整生命年 (QALY) 数。数据来源包括 II 期和 III 期试验以及长期毒性和健康状况公用事业的文献估计。使用荟萃分析方法得出治疗方案相关参数的值和范围。根据我们的模型，与最大预期质量调整生命年相关的策略是在一线治疗中使用 RCHOP 治疗，然后在二线治疗中使用 RFlu 治疗（9.00 QALY）。在一线或二线治疗中包含 RCVP 的策略导致 QALY 数量最低（范围 6.24-7.71）。用于确定每个模型参数的相对贡献的敏感性分析确定一线治疗后的 PFS 而不是短期 QOL 是延长总体质量调整生命年的最重要因素。我们的结果表明，与较长 PFS 相关的治疗方案可提供更多的总 QALY，尽管它们存在短期毒性。对于没有任何这些治疗方案禁忌症的患者，使用更积极的治疗方案可以最大限度地提高整体生活质量。是。 J.赫马托尔。 2010。© 2010 Wiley-Liss, Inc.
Combination immunochemotherapy is the most common approach for initial therapy of patients with advanced‐stage follicular lymphoma, but no consensus exists as to the optimal selection or sequence of available regimens. We undertook this decision analysis to systematically evaluate the parameters affecting the choice of early therapy in patients with this disease. We designed a Markov model incorporating the three most commonly utilized regimens (RCVP, RCHOP, and RFlu) in combinations of first‐ and second‐line therapies, with the endpoint of number of quality‐adjusted life years (QALYs) until disease progression. Data sources included Phase II and Phase III trials and literature estimates of long‐term toxicities and health state utilities. Meta‐analytic methods were used to derive the values and ranges of regimen‐related parameters. Based on our model, the strategy associated with the greatest number of expected quality‐adjusted life years was treatment with RCHOP in first‐line therapy followed by treatment with RFlu in second‐line therapy (9.00 QALYs). Strategies containing RCVP either in first‐ or second‐line therapy resulted in the lowest number of QALYs (range 6.24–7.71). Sensitivity analysis used to determine the relative contribution of each model parameter identified PFS after first‐line therapy and not short‐term QOL as the most important factor in prolonging overall quality‐adjusted life years. Our results suggest that regimens associated with a longer PFS provide a greater number of total QALYs, despite their short‐term toxicities. For patients without contraindications to any of these regimens, use of a more active regimen may maximize overall quality of life. Am. J. Hematol. 2010. © 2010 Wiley‐Liss, Inc.