大劑量化療后自體干細胞移植一線治療濾泡性淋巴瘤的Meta分析_《中國循證醫學雜志》

作者：

朱珂 , 楊瑩 , 楊威 , 張嶸 , 胡榮 , 蔣本春 ,  劉卓剛

中國醫科大學附屬盛京醫院（沈陽 110004）;

關鍵詞：

大劑量化療自體干細胞移植濾泡性淋巴瘤隨機對照試驗 Meta分析

DOI：

10.7507/1672-2531.20100565

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目的　系統評價大劑量化療后自體干細胞移植一線治療濾泡性淋巴瘤的臨床療效與安全性。
方法　計算機檢索MEDLINE（1990～2009）、EMbase（1990～2009）、OVID（1990～2009）和Cochrane圖書館（2009年第2期），手工檢索美國血液年會（ASH）會議記錄及相關文獻的參考文獻，評價納入研究的方法學質量，采用STATA 10.0軟件和RevMan 4.3軟件進行統計分析。
結果　共納入4個隨機對照試驗，包括941 例患者。Meta分析結果顯示：大劑量化療后自體干細胞移植一線治療濾泡性淋巴瘤與常規化療相比，總生存率［RR=1.02，95%CI（0.94，1.11），P=0.59］、總緩解率［RR=0.96，95%CI（0.71，1.30），P=0.78］、繼發惡性腫瘤發生率方面，兩組差異無統計學意義，但在無事件生存率方面［RR=1.61，95%CI（1.25，2.07），P=0.000 2］，大劑量化療后自體干細胞移植治療優于常規治療。
結論　現有證據表明，大劑量化療后自體干細胞移植一線治療濾泡性淋巴瘤與常規化療相比，不能改善患者的總生存率及總緩解率，但能提高無事件生存率，不增加繼發惡性腫瘤發生的風險。本研究納入病例數較少，結論尚需高質量多中心大樣本隨機對照試驗證實。

引用本文： 朱珂,楊瑩,楊威,張嶸,胡榮,蔣本春,劉卓剛. 大劑量化療后自體干細胞移植一線治療濾泡性淋巴瘤的Meta分析. 中國循證醫學雜志, 2010, 10(10): 1169-1173. doi: 10.7507/1672-2531.20100565 復制

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1. Colombat P, Donadio D, Fouillard L, et al. Value of autologous bone marrow transplantation in follicular lymphoma: a France autogreffe retrospective study of 42 patients. Bone Marrow Transplant, 1994, 13: 157-162.
2. Brice P, Simon D, Bouabdallah R, et al. High-dose therapy with autologous stem-cell transplantation (ASCT) after ?rst progression prolonged survival of follicular lymphoma patients included in the prospective GELF 86 protocol. Ann Oncol, 2000, 11: 1585-1590.
3. Rohatiner AZ, Johnson PW, Price CG, et al. Myeloablative therapy with autologous bone marrow transplantation as consolidation therapy for recurrent follicular lymphoma. J Clin Oncol, 1994, 12: 1177-1184.
4. Rohatiner AZ, Nadler L, Davies AJ, et al. Myeloablative therapy with autologous bone marrow transplantation for follicular lymphoma at the time of second or subsequent remission: long-term follow-up. J Clin Oncol, 2007, 25: 2554-2559.
5. Le Gouill, Steven, De Guibert, et al. Autologous stem cell transplantation as the treatment of choice for follicular lymphoma patients in the first replase:final analysis of the outcome of 175 patients treated in the GELA/GOELAMS FL 2000 study. Blood, 2008, 112(11): 287.
6. Hiddeman L, Wolfgang MY, Buske AH, et al. Autologous stem cell transplantation after myeloablative therapy in first remission may be beneficial in patients with advanced stage follicular lymphoma after front-line therapy with R-CHOP. An analysis of two consecutive studies of the German low grade lymphoma study group (GLSG). Blood, 2008, 112(11): 286-287.
7. Sebban C, Mounier N, Brousse N, et al. Standard chemotherapy with interferon compared with CHOP followed by high-dose therapy with autologous stem cell transplantation in untreated patients with advanced follicular lymphoma: the GELF-94 randomized study from the Groupe d’Etude des Lymphomes de l’Adulte (GELA). Blood, 2006, 108: 2540-2544.
8. Deconinck E, Foussard C, Milpied N, et al. High-dose therapy followed by autologous purged stem-cell transplantation and doxorubicin-based chemotherapy in patients with advanced follicular lymphoma:a randomized multicenter study by GOELAMS.Blood, 2005, 105: 3817-3823.
9. Lenz G, Dreyling M, Schiegnitz E, et al. Myeloablative radiochemotherapy followed by autologous stem cell transplantation in first remission prolongs progression-free survival in follicular lymphoma: results of a prospective, randomized trial of the German Low-Grade Lymphoma Study Group. Blood, 2004, 104: 2667-2674.
10. Ladetto M, Marco FD, Benedetti F, et al. Prospective, multicenter randomized GITMO/IIL trial comparing intensive (R-HDS) versus conventional (CHOP-R) chemoimmunotherapy in high-risk follicular lymphoma at diagnosis: the superior disease control of R-HDS does not translate into an overall survival advantage. Blood, 2008, 111: 4004-4013.

《中國循證醫學雜志》

大劑量化療后自體干細胞移植一線治療濾泡性淋巴瘤的Meta分析

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《中國循證醫學雜志》

大劑量化療后自體干細胞移植一線治療濾泡性淋巴瘤的Meta分析

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