Systematic Review Of High-dose Chemotherapy Followed By Autologous Stem Transplantation As First-line Therapy In Aggressive Non-Hodgkin's Lymphoma

Objective:To evaluate the HDCT/ASCT efficacy in first-line treating NHL.Based on searching results of HDCT/ASCT randomized clinical trials(RCTs)in first-line treating NHL,We used system review and Meta analysis to assess the evidence-based medicine results of HDCT/ASCT clinical effects and apply it to clinical practice.Methods:Search strategy,MEDLINE,EMBASE,CBM,VIP,CMCC,CNKI databases were chosen for primary document search.The Cochrane Library (2007,Tissue 3):The Cochrane Central Register of Controlled Trials (CENTRAL),The National Research Register,Health technology assessment database(HTA)were chosen for secondary document search.Published Chinese articles in relative journals,conference proceedings and thesis were manually searched and some other articles were searched with Google.The references were investigated,the data and full text were traced with E-mail.All searches were conducted for the period between 1990 and 8/2007.Two reviewers assessed the documents quality separately,they cross check them.Discussion or the third reviewer was invited when the discrepancy happened.The outcome indexes were mortality,complete response,event-free survival,impact of IPI risk factors.STATA10.0 software were used for statistical analysis.Both fixed and random effects models were assumed in all meta-analyses.The main estimate indexes:odds ratio(OR),95%confidence intervals(CI).Results:2334 NHL patients in 15 RCTs were investigated,in which 3 trials were composed of 1 report in different treating periods.Potential causes of heterogeneity were explored with subgroup analyses,such as the method of trial design,patients'characteristics,factors about treating,including proportion of patients with bulky disease;treatment regimen before HDCT(no induction, abbreviated or full standard induction),proportion of patients who actually received HDCT,and aaIPI score.Poor risk patients were those with intermediate-high and high risk factors.There was some evidence for HDCT/ASCT to improve event-free survival(EFS)(ORI.17,CI 1.02-1.35) compared to conventional chemotherapy.In conclusion,the meta-analysis didn't show that HDCT/ASCT decrease modality(OR1.04,CI0.89-1.21,P=0.24) compared to conventional chemotherapy.The results of different prospectively randomized clinical trials among poor risk patients gave conflicting results: some decreased modality,some increase modality.Conclusions:The major trend of 13 HDCT's RCTs were as follows:(1)Comparing the impact of HDCT/ASCT in the first-line treatment of patients with aggressive NHL,there was no evidence for HDCT to decrease modality.(2)There was no evidence for HDCT/ASCT to improve CR.(3)In the analyses of outcome indexes of EFS,there was some evidence for HDCT to improve EFS. (4)There was no evidence that poor risk patients benefit from HDCT.Due to articles quality,intervention therapies diversity,experimental methods quality,more large sample RCTs should be designed reasonably and investigated to make the final clinical treating therapy.