观察全身照射加环磷酰胺(TBI/CY)与白消安加环磷酰胺(BU/CY)治疗小儿造血干细胞移植的疗效及不良反应发生情况。
通过搜索Cochrane图书馆,PubMed,WebofKnowledge,Embase,中国生物医学文献数据库(CBM),和筛选随机对照试验(RCTs),对纳入的文献进行了质量评价和数据提取,使用ReviewManager5.2软件对纳入的随机对照试验进行荟萃分析。
共有10160名患者参加了15项随机对照试验,其中TBI/CY组5211例,BU/CY组4949例。Meta分析显示移植失败率差异有统计学意义(OR=1.56,95%CI(1.23,1.97),P=0.0002,I2=56%,Z=3.69),移植死亡率(OR=1.45,95%CI(1.24,1.68),P<0.00001,I2=76%,Z=4.80),移植长期无病生存率(OR=1.52,95%CI(1.09,2.12),P=0.01,I2=0%,Z=2.50),移植不良反应(OR=1.28,95%CI(1.08,1.52),P=0.004,I2=0%,Z=2.85)。
Meta分析显示,TBI/CY联合预处理方案比BU/CY方案单独治疗小儿血液移植更有效。具有较低的不良反应发生率和显著的长期生存疗效。
To observe the therapeutic effect and the incidence of adverse reactions of total body irradiation plus cyclophosphamide (TBI/CY) and
busulfan plus cyclophosphamide (BU/CY) in the treatment of pediatric hematopoietic stem cell transplantation.
By searching the Cochrane Library, PubMed, Web of Knowledge, Embase, Chinese Biomedical Literature Database (CBM), and screening randomized controlled trials (RCTs), quality evaluation and data extraction were performed for the included literature, and meta-analysis was performed for RCTs included at using
Review Manager 5.2 software.
A total of 10160 patients were enrolled in 15 RCTs, including 5211 patients in the TBI/CY group and 4949 patients in the BU/CY group. Meta-analysis showed that there was a statistical difference in transplant failure rate (OR = 1.56, 95% CI (1.23, 1.97), P = 0.0002, I 2 = 56%, Z = 3.69), transplant mortality (OR = 1.45, 95% CI (1.24, 1.68), P < 0.00001, I 2 = 76%, Z = 4.80), transplantation long-term disease-free survival rate (OR = 1.52, 95% CI (1.09, 2.12), P = 0.01, I 2 = 0%, Z = 2.50), and transplantation adverse reactions (OR = 1.28, 95% CI (1.08, 1.52), P = 0.004, I 2 = 0%, Z = 2.85).
Meta-analysis showed that TBI/CY combined pretreatment regimen was more effective than BU/CY regimen alone in the treatment of pediatric hematologic transplantation, with a lower incidence of adverse reactions and significant long-term survival efficacy.