大剂量化疗后自体干细胞移植一线治疗滤泡性淋巴瘤的Meta分析  

Autologous Stem Cell Transplantation after High-dose Chemotherapy in First-line Treatment of Follicular Lymphoma: A Meta-analysis

作　　者：朱珂[1] 杨莹[1] 杨威[1] 张嵘[1] 胡荣[1] 蒋本春[1] 刘卓刚[1] 

机构地区：[1]中国医科大学附属盛京医院,沈阳110004

出　　处：《中国循证医学杂志》2010年第10期1169-1173,共5页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价大剂量化疗后自体干细胞移植一线治疗滤泡性淋巴瘤的临床疗效与安全性。方法计算机检索MEDLIN(E1990～2009)、EMbase(1990～2009)、OVID(1990～2009)和Cochrane图书馆(2009年第2期),手工检索美国血液年会(ASH)会议记录及相关文献的参考文献,评价纳入研究的方法学质量,采用STATA10.0软件和RevMan4.3软件进行统计分析。结果共纳入4个随机对照试验,包括941例患者。Meta分析结果显示:大剂量化疗后自体干细胞移植一线治疗滤泡性淋巴瘤与常规化疗相比,总生存率[RR=1.02,95%CI(0.94,1.11),P=0.59]、总缓解率[RR=0.96,95%CI(0.71,1.30),P=0.78]、继发恶性肿瘤发生率方面,两组差异无统计学意义,但在无事件生存率方面[RR=1.61,95%CI(1.25,2.07),P=0.000-2],大剂量化疗后自体干细胞移植治疗优于常规治疗。结论现有证据表明,大剂量化疗后自体干细胞移植一线治疗滤泡性淋巴瘤与常规化疗相比,不能改善患者的总生存率及总缓解率,但能提高无事件生存率,不增加继发恶性肿瘤发生的风险。本研究纳入病例数较少,结论尚需高质量多中心大样本随机对照试验证实。Objective To assess the effectiveness and safety of autologous stem cell transplantation after high-dose chemotherapy in rst-line treatment of follicular lymphoma. Method Randomized controlled trials （RCTs） of autolo-gous stem cell transplantation after high-dose chemotherapy in rst-line treatment of follicular lymphoma were collected from MEDLINE （1990-2009）, EMBASE （1990-2009）, OVID （1990-2009）, and the Cochrane Library （Issue 2, 2009）, and the proceedings of ASH were searched manually. The methodological quality of included studies was evaluated, and data analysis was performed with software STATA 10.0 and RevMan 4.3. Result A total of 4 RCTs involving 941 patients were included. The results of meta-analysis showed that overall survival rate （HR=0.82, 95%CI 0.49 to 1.15）, event-free survival rate （HR=0.35, 95%CI 0.24 to 0.47）, total remission rate （RR=0.35, 95%CI 0.96 to 1.30）, and secondary malignant tumor incidence rate （RR=1.68, 95%CI 0.47 to 6.07）. Conclusion According to the present evidences, autologous stem cell transplantation after high-dose chemotherapy can not improve overall survival rate and total remission rate, but can improve event-free survival rate, and do not increase secondary malignant tumor incidence rate. However, more high-quality, multiple-center, large-sample randomized controlled trials are required.

关 键 词：大剂量化疗 自体干细胞移植 滤泡性淋巴瘤 随机对照试验 META分析 

分 类 号：R733.1[医药卫生—肿瘤]