Hematologic Neoplasms

血液肿瘤
  • 文章类型: Editorial
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  • 文章类型: Systematic Review
    目的:评估恶性血液病患者外周静脉置管(PICC)相关性静脉血栓形成的发生率。
    方法:对儿童PICC相关静脉血栓形成的观察性研究进行系统评价,成年人,并对患有血液系统恶性肿瘤的老年人进行了研究。6月12日进行了搜索,2023年在PubMed上,CINAHL,Embase,WebofScience核心合集,Scopus,和LILACS,谷歌学者的灰色文献,和ProQuest学位论文和论文全球。合格标准由两名审稿人独立应用,首先是Rayyan平台上的标题和摘要,然后是合格研究的全文。通过JBI检查表评估偏倚风险。数据进行了描述性总结,使用MetaXL5.3软件进行荟萃分析。审查遵循JBI指南和PRISMA报告。
    结果:在包括的40项研究中,PICC相关静脉血栓形成的患病率一般为9%,9%的成年人6%的儿童患有血液系统恶性肿瘤。大多数研究仅评估症状性血栓形成的病例(n=25;64%)。
    结论:使用PICC的血液系统恶性肿瘤患者的PICC相关静脉血栓形成的估计患病率为9%,由于主要考虑有症状的病例,这一比率可能被低估。
    OBJECTIVE: To estimate the prevalence of peripherally inserted central catheter (PICC)-related venous thrombosis in patients with hematological malignancies.
    METHODS: A systematic review of observational studies that evaluated the occurrence of PICC-related venous thrombosis in children, adults, and older people with hematological malignancies was conducted. Searches were carried out on June 12th, 2023 on PubMed, CINAHL, Embase, Web of Science Core Collection, Scopus, and LILACS, and to gray literature on Google Scholar, and ProQuest Dissertations and Theses Global. Eligibility criteria were applied independently by two reviewers, first on the titles and abstracts on the Rayyan platform and then on the full text of eligible studies. Risk of bias was assessed by the JBI checklist. Data were summarized descriptively, and the meta-analysis was carried out using the MetaXL 5.3 software. The review followed JBI guidelines and PRISMA for reporting.
    RESULTS: In the 40 studies included, prevalence of PICC-related venous thrombosis was 9% in general, 9% in adults, and 6% in children with hematological malignancies. Most studies only evaluated cases of symptomatic thrombosis (n = 25; 64%).
    CONCLUSIONS: Patients with hematological malignancies using PICC have an estimated prevalence of PICC-related venous thrombosis of 9%, and this rate may be underestimated due to the consideration of mostly symptomatic cases.
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  • 文章类型: Journal Article
    背景:造血干细胞移植(HSCT)是青少年和年轻人(15-39岁)血液系统恶性肿瘤的一种挽救生命的治疗方法。鉴于在这个独特的生命阶段通常取得的重要发展里程碑,这一人群特别容易受到癌症诊断和治疗的干扰。HSCT是一种特别侵入性的癌症治疗形式,具有许多负面的身体,社会,心理后遗症。HSCT对青少年和青少年血液系统恶性肿瘤的长期影响值得对其影响进行系统研究,以最好地制定临床护理和卫生政策。
    方法:该方案的系统评价将侧重于长期的身体,心理,社会,精神,以及接受HSCT治疗恶性血液病的青少年和年轻人所经历的健康行为影响。我们构建了一个特定的搜索策略来查询这五个领域,它将应用于五个数据库-Embase,PubMed,Cochrane试验和评论,PsychInfo,和CINAHL-确定关键文献。两名独立的审阅者将执行标题/摘要屏幕,然后使用标准筛选模板进行全文屏幕,以确保在急性HSCT后期间纳入结果。偏差风险将使用阿德莱德大学乔安娜布里格斯研究所合作关键评估工具进行评估。纳入研究的数据将根据研究特征进行抽象,研究设置,样本特征,和结果。鉴于研究问题的广泛范围,数据综合将侧重于根据医学研究所标准的定性方法。
    结论:虽然接受造血干细胞移植治疗恶性血液病的青少年和年轻人被认为具有独特的生存经历,这种治疗方法在该人群中的后遗症以前尚未汇总。这项系统评价旨在扩大对青少年和年轻成人HSCT经历的洞察力,以便为适合年龄的生存护理提供信息,并以最佳结果提供这种挽救生命的干预措施。
    背景:PROSPEROCRD42022361663.
    BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is a life-saving treatment for adolescents and young adults (ages 15-39) with hematologic malignancy. Given the significant developmental milestones usually achieved during this unique life stage, this population is especially vulnerable to the interruption caused by a cancer diagnosis and its treatment. HSCT is a particularly invasive form of cancer therapy with many negative physical, social, and psychological sequelae. The long-term impact of HSCT in adolescents and young adults with hematologic malignancies warrants a systematic investigation of its effects to best shape clinical care and health policy.
    METHODS: This protocol for a systematic review will focus on the long-term physical, psychological, social, spiritual, and health behavior effects experienced by adolescents and young adults who undergo HSCT for hematologic malignancy. We have constructed a specific search strategy that queries these five domains, which will be applied to five databases-Embase, PubMed, Cochrane Trials and Reviews, PsychInfo, and CINAHL-to identify the key literature. Two independent reviewers will perform a title/abstract screen followed by a full-text screen using standard screening templates to ensure the inclusion of outcomes in the post-acute HSCT period. Risk of bias will be assessed using the University of Adelaide Joanna Briggs Institute Collaboration Critical Appraisal Tools. Data from included studies will be abstracted on study characteristics, study setting, sample characteristics, and outcomes. Given the broad scope of the research question, data synthesis will focus on qualitative methods in accordance with Institute of Medicine standards.
    CONCLUSIONS: While adolescents and young adults undergoing hematopoietic stem cell transplantation for hematologic malignancy are understood to have a unique survivorship experience, the sequelae of this treatment approach in this population have not been previously aggregated. This systematic review intends to expand insight into the adolescent and young adult experiences with HSCT in order to inform age-appropriate survivorship care and deliver this life-saving intervention with the best possible outcomes.
    BACKGROUND: PROSPERO CRD42022361663.
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  • 文章类型: Journal Article
    据报道,PIM激酶(PIM-1,PIM-2和PIM-3)在控制细胞存活的信号级联中起关键作用,扩散,和差异化。这些激酶的过度表达导致血液恶性肿瘤,如弥漫性大B细胞淋巴瘤(DLBCL),多发性骨髓瘤,白血病,淋巴瘤和前列腺癌等.PIM激酶作为生物标志物和潜在的治疗靶标已显示出对精确癌症治疗的希望。选择性PIM-1、PIM-2和/或PIM-3同种型抑制剂已经在患有晚期癌症(包括复发性/难治性癌症)的患者中显示出显著结果。
    关于PIM激酶(PIM-1,PIM-2和PIM-3)在肿瘤发生中的综合文献综述,获得专利的PIM激酶抑制剂(2016年至今),和他们的药理学和结构见解已被强调。
    最近,PIM激酶即.作为治疗靶标的PIM-1、PIM-2和PIM-3(丝氨酸/苏氨酸蛋白激酶家族的成员)已经在肿瘤学特别是血液恶性肿瘤中引起了相当大的兴趣。专利的PIM激酶抑制剂由杂环(稠合)环结构(如吲哚)组成,吡啶,吡嗪,吡唑,吖嗪,哌嗪,噻唑,恶二唑,喹啉,三唑并吡啶,吡唑并吡啶,咪唑并吡啶嗪,恶二唑-硫酮,吡唑并嘧啶,三唑并吡啶嗪,咪唑并吡啶嗪,吡唑并喹唑啉和吡唑并吡啶等。在癌症化疗中显示出有希望的结果。
    UNASSIGNED: PIM Kinases (PIM-1, PIM-2, and PIM-3) have been reported to play crucial role in signaling cascades that govern cell survival, proliferation, and differentiation. Over-expression of these kinases leads to hematological malignancies such as diffuse large B cell lymphomas (DLBCL), multiple myeloma, leukemia, lymphoma and prostate cancer etc. PIM kinases as biomarkers and potential therapeutic targets have shown promise toward precision cancer therapy. The selective PIM-1, PIM-2, and/or PIM-3 isoform inhibitors have shown significant results in patients with advanced stages of cancer including relapsed/refractory cancer.
    UNASSIGNED: A comprehensive literature review of PIM Kinases (PIM-1, PIM-2, and PIM-3) in oncogenesis, the patented PIM kinase inhibitors (2016-Present), and their pharmacological and structural insights have been highlighted.
    UNASSIGNED: Recently, PIM kinases viz. PIM-1, PIM-2, and PIM-3 (members of the serine/threonine protein kinase family) as therapeutic targets have attracted considerable interest in oncology especially in hematological malignancies. The patented PIM kinase inhibitors comprised of heterocyclic (fused)ring structure(s) like indole, pyridine, pyrazine, pyrazole, pyridazine, piperazine, thiazole, oxadiazole, quinoline, triazolo-pyridine, pyrazolo-pyridine, imidazo-pyridazine, oxadiazole-thione, pyrazolo-pyrimidine, triazolo-pyridazine, imidazo-pyridazine, pyrazolo-quinazoline and pyrazolo-pyridine etc. showed promising results in cancer chemotherapy.
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  • 文章类型: Journal Article
    与没有恶性血液病(HMs)的患者相比,患有恶性血液病(HMs)的患者感染COVID-19并经历严重后果的风险明显更高。包括潜在的恶性肿瘤,免疫抑制治疗,和患者相关因素。值得注意的是,通常用于HM治疗的免疫抑制方案可以导致B细胞和T细胞的消耗,这与这些患者的COVID-19相关并发症和死亡率增加有关。随着大流行转变为流行状态,承认和解决患有HMs的个人的持续风险仍然至关重要。在这篇综述中,我们的目标是总结目前的证据,以加强我们对HMs对COVID-19风险和结果的影响的理解,识别特别脆弱的个人,并强调需要专门的临床关注和管理。此外,在这些患者中观察到的对COVID-19疫苗接种的免疫反应受损,强调了实施其他缓解策略的重要性.如所示,这可以包括靶向预防和用抗病毒剂和单克隆抗体治疗。提供实际指导和考虑,我们提出了两个说明性的案例,以强调照顾HMs患者的医生所面临的现实生活中的挑战,强调需要根据疾病严重程度进行个性化管理,type,以及每个病人的独特情况。
    Patients with hematologic malignancies (HMs) are at a significantly higher risk of contracting COVID-19 and experiencing severe outcomes compared to individuals without HMs. This heightened risk is influenced by various factors, including the underlying malignancy, immunosuppressive treatments, and patient-related factors. Notably, immunosuppressive regimens commonly used for HM treatment can lead to the depletion of B cells and T cells, which is associated with increased COVID-19-related complications and mortality in these patients. As the pandemic transitions into an endemic state, it remains crucial to acknowledge and address the ongoing risk for individuals with HMs. In this review, we aim to summarize the current evidence to enhance our understanding of the impact of HMs on COVID-19 risks and outcomes, identify particularly vulnerable individuals, and emphasize the need for specialized clinical attention and management. Furthermore, the impaired immune response to COVID-19 vaccination observed in these patients underscores the importance of implementing additional mitigation strategies. This may include targeted prophylaxis and treatment with antivirals and monoclonal antibodies as indicated. To provide practical guidance and considerations, we present two illustrative cases to highlight the real-life challenges faced by physicians caring for patients with HMs, emphasizing the need for individualized management based on disease severity, type, and the unique circumstances of each patient.
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  • 文章类型: Journal Article
    已发表的研究表明,患者报告的结果(PRO)在实体瘤的随机临床试验(RCT)中既不常见也不报道。对于血液恶性肿瘤的RCT中的这些实践知之甚少。
    为了评估血液恶性肿瘤RCT中作为预设终点的PROs的患病率,并评估相关试验出版物中的PRO报告。
    以出版高影响力RCT而闻名的8种期刊的所有问题(NEJM,柳叶刀,柳叶刀血液学,柳叶刀肿瘤学,临床肿瘤学杂志,血,JAMA,和JAMAOncology)在2018年1月1日至2022年12月13日之间进行了搜索,以查找针对成人血液恶性肿瘤的治疗性3期试验的主要出版物。评估移植前预处理方案的研究,移植物抗宿主病治疗,或放疗作为实验治疗被排除。从手稿和试验方案中提取有关试验特征和PRO的数据。单变量分析评估了试验特征与PRO收集或报告之间的关联。
    90个随机对照试验符合分析条件。在66项(73%)试验中,PRO是终点:在1项试验(1%)中,PRO是主要终点,在50(56%)作为次要终点,15(17%)作为探索性终点。在66份主要出版物中,有26份报告了PRO数据(39%):18份结果没有变化,8份结果有所改善,没有一份报告试验治疗的PRO较差。由营利性实体赞助的试验更有可能将PRO作为终点(55中的49个[89%]对35中的17个[49%];P<.001),但报告PRO数据的可能性并不明显(49中的20个[41%]对17中的6个[35%];P=.69)。与涉及淋巴瘤(29个中的18个[62%])或白血病或骨髓增生异常综合征(28个中的18个[64%])的试验相比,那些涉及浆细胞疾病或多发性骨髓瘤(27/30[90%])或骨髓增殖性肿瘤(3/3[100%])的患者更有可能将PRO作为终点(P=0.03).同样,与涉及淋巴瘤(18个中的3个[17%])或白血病或骨髓增生异常综合征(18个中的5个[28%])的试验相比,涉及浆细胞疾病或多发性骨髓瘤(27人中的16人[59%])或骨髓增殖性肿瘤(3人中的2人[67%])的患者更有可能在主要出版物中报告PROs(P=.01).
    在这篇系统综述中,几乎每4个血癌治疗RCT中就有3个收集了PRO数据;然而,只有1个RCT包含PRO作为主要终点。此外,大多数人没有在主要出版物中报告由此产生的PRO数据,当报告时,PROs要么更好,要么没有变化,引起对出版偏见的关注。该分析表明,在血液恶性肿瘤RCT患者的生活经历数据传播方面存在严重差距。
    UNASSIGNED: Published research suggests that patient-reported outcomes (PROs) are neither commonly collected nor reported in randomized clinical trials (RCTs) for solid tumors. Little is known about these practices in RCTs for hematological malignant neoplasms.
    UNASSIGNED: To evaluate the prevalence of PROs as prespecified end points in RCTs of hematological malignant neoplasms, and to assess reporting of PROs in associated trial publications.
    UNASSIGNED: All issues of 8 journals known for publishing high-impact RCTs (NEJM, Lancet, Lancet Hematology, Lancet Oncology, Journal of Clinical Oncology, Blood, JAMA, and JAMA Oncology) between January 1, 2018, and December 13, 2022, were searched for primary publications of therapeutic phase 3 trials for adults with hematological malignant neoplasms. Studies that evaluated pretransplant conditioning regimens, graft-vs-host disease treatment, or radiotherapy as experimental treatment were excluded. Data regarding trial characteristics and PROs were extracted from manuscripts and trial protocols. Univariable analyses assessed associations between trial characteristics and PRO collection or reporting.
    UNASSIGNED: Ninety RCTs were eligible for analysis. PROs were an end point in 66 (73%) trials: in 1 trial (1%) as a primary end point, in 50 (56%) as a secondary end point, and in 15 (17%) as an exploratory end point. PRO data were reported in 26 of 66 primary publications (39%): outcomes were unchanged in 18 and improved in 8, with none reporting worse PROs with experimental treatment. Trials sponsored by for-profit entities were more likely to include PROs as an end point (49 of 55 [89%] vs 17 of 35 [49%]; P < .001) but were not significantly more likely to report PRO data (20 of 49 [41%] vs 6 of 17 [35%]; P = .69). Compared with trials involving lymphoma (18 of 29 [62%]) or leukemia or myelodysplastic syndrome (18 of 28 [64%]), those involving plasma cell disorders or multiple myeloma (27 of 30 [90%]) or myeloproliferative neoplasms (3 of 3 [100%]) were more likely to include PROs as an end point (P = .03). Similarly, compared with trials involving lymphoma (3 of 18 [17%]) or leukemia or myelodysplastic syndrome (5 of 18 [28%]), those involving plasma cell disorders or multiple myeloma (16 of 27 [59%]) or myeloproliferative neoplasms (2 of 3 [67%]) were more likely to report PROs in the primary publication (P = .01).
    UNASSIGNED: In this systematic review, almost 3 of every 4 therapeutic RCTs for blood cancers collected PRO data; however, only 1 RCT included PROs as a primary end point. Moreover, most did not report resulting PRO data in the primary publication and when reported, PROs were either better or unchanged, raising concern for publication bias. This analysis suggests a critical gap in dissemination of data on the lived experiences of patients enrolled in RCTs for hematological malignant neoplasms.
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  • 文章类型: Journal Article
    已经开发并发表了几种B细胞淋巴瘤2(BCL-2)维奈托克(VEN)的群体药代动力学(PPK)模型,以表征血液恶性肿瘤中药代动力学的影响因素。这篇综述描述了VEN的PPK模型,检查了PK参数中协变量效应的大小和类型,以及需要进一步调查以方便其使用的已确定区域。目前,这篇综述总结了六项关于VENPPK模型的分析。大多数分析用两室模型描述了VEN的药代动力学,所有协变量都是分类的。中值估计表观清除率(CL/F)为446L/天,并且中央隔室的表观分布体积(V2/F)为114.5L。报告的CL/F的中值IIV为39.5%,V2/F为46.7%。最常见的是,CYP3A抑制剂,发现OATP1B3抑制剂和利妥昔单抗共同给药是CL/F的重要协变量。此外,性别和人口是V2/F的影响协变量。这篇综述详细介绍了VEN的PPK模型的特点,以及协变量对PK参数的影响。对于VENPPK模型的未来发展,CYP3A抑制剂,利妥昔单抗联合用药,OATP1B1转运蛋白抑制剂,性别,人口,食物可以考虑。应进行进一步研究和全面调查,以探索治疗药物监测的参考范围,定义脑脊液并发症患者的潜在作用,并评估新的或潜在的协变量。这些努力将促进个性化VEN治疗的发展。
    Several population pharmacokinetic (PPK) models of B cell lymphoma-2 (BCL-2) venetoclax (VEN) have been developed and published to characterize the influencing factors of pharmacokinetics in hematologic malignancies. This review described PPK models of VEN examining the magnitude and types of covariate effects in PK parameters, as well as identified areas that require further investigation in order to facilitate their use. Currently, there are six analyses on PPK models of VEN summarized in this review. Most analyses described the pharmacokinetics of VEN with a two-compartment model and all covariates are categorical. The median estimated apparent clearance (CL/F) was 446 L/Day and apparent volume of distribution of the central compartment (V2/F) was 114.5 L. The median IIV of CL/F reported was 39.5% and V2/F was 46.7%. Most commonly, CYP3A inhibitors, OATP1B3 inhibitors and rituximab co-administration were found to be significant covariates on CL/F. In addition, sex and population were influential covariates on V2/F. A detailed description of the characteristics of PPK models of VEN is provided in this review, as well as the effects of covariates on the PK parameters. For future development of the VEN PPK model, CYP3A inhibitors, rituximab co-administration, OATP1B1 transporter inhibitors, sex, population, and food might be considered. Further research and comprehensive investigations should be undertaken to explore reference ranges for therapeutic drug monitoring, define the potential role of patients with cerebrospinal fluid complications, and assess new or potential covariates. These endeavors will facilitate the development of personalized VEN therapy.
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  • 文章类型: Journal Article
    硫化氢(H2S)是体内三种最关键的气态信使之一。H2S供体的发现,再加上它的内生合成能力,给血液系统恶性肿瘤的治疗带来了希望.在过去的十年里,对H2S影响的调查已经扩大,特别是在心血管功能领域,炎症,感染,和神经调节。血液恶性肿瘤是指由造血细胞的异常增殖和分化引起的多种癌症。包括白血病,淋巴瘤和骨髓瘤。在这次审查中,我们深入研究了H2S与恶性血液病之间复杂的相互关系.此外,我们全面阐明了H2S及其供体复杂调节肿瘤生长进展的分子机制。此外,我们系统地研究了它们对关键方面的影响,包括扩散,入侵,血液系统恶性肿瘤的迁移能力。因此,这篇综述可能为我们理解血液系统恶性肿瘤领域H2S及其供体的前瞻性治疗意义提供新的见解.
    Hydrogen sulfide (H2S) is one of the three most crucial gaseous messengers in the body. The discovery of H2S donors, coupled with its endogenous synthesis capability, has sparked hope for the treatment of hematologic malignancies. In the last decade, the investigation into the impact of H2S has expanded, particularly within the fields of cardiovascular function, inflammation, infection, and neuromodulation. Hematologic malignancies refer to a diverse group of cancers originating from abnormal proliferation and differentiation of blood-forming cells, including leukemia, lymphoma, and myeloma. In this review, we delve deeply into the complex interrelation between H2S and hematologic malignancies. In addition, we comprehensively elucidate the intricate molecular mechanisms by which both H2S and its donors intricately modulate the progression of tumor growth. Furthermore, we systematically examine their impact on pivotal aspects, encompassing the proliferation, invasion, and migration capacities of hematologic malignancies. Therefore, this review may contribute novel insights to our understanding of the prospective therapeutic significance of H2S and its donors within the realm of hematologic malignancies.
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  • 文章类型: Journal Article
    嵌合抗原受体T细胞(CAR-T)疗法改变了血液恶性肿瘤的治疗前景,在CAR-T之前的复发或难治性(R/R)疾病和其他不良预后患者中显示高疗效。由于细胞因子释放综合征(CRS)和免疫效应细胞相关神经毒性综合征(ICANS)的风险,这些疗法通常在住院患者中使用。然而,由于多种原因,人们对过渡到门诊管理越来越感兴趣。我们回顾了有关CD19靶向和BCMA靶向CAR-T细胞治疗的门诊安全性和可行性的现有证据,重点是在社区中心实施门诊CAR-T计划。
    Chimeric Antigen Receptor T-cell (CAR-T) therapy has transformed the treatment landscape for hematological malignancies, showing high efficacy in patients with relapsed or refractory (R/R) disease and otherwise poor prognosis in the pre-CAR-T era. These therapies have been usually administered in the inpatient setting due to the risk of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). However, there is a growing interest in the transition to outpatient administration due to multiple reasons. We review available evidence regarding safety and feasibility of outpatient administration of CD19 targeted and BCMA targeted CAR T-cell therapy with an emphasis on the implementation of outpatient CAR-T programs in community-based centers.
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  • 文章类型: Systematic Review
    目的:恶性血液病患者可能发生低丙种球蛋白血症。免疫球蛋白(Ig)通常用于预防感染,但它的总成本和成本效益是未知的。
    方法:根据PRISMA指南进行了系统评价,以评估Ig的成本和成本效益的证据,静脉内(IVIg)或皮下(SCIg)给药,成人血液系统恶性肿瘤。
    结果:六项研究符合纳入标准,仅确定了两项经济评估;一项IVIg与无Ig的成本效用分析(CUA),和另一个比较IVIg与SCIg。证据的质量很低。与没有治疗相比,Ig降低了住院率。一项研究报告说,在减少IVIg使用的计划之后,住院率没有显着变化。一项比较IVIg和SCIg的观察性研究表明,SCIg的住院次数更多,但每位患者的总费用更低.比较IVIg和无Ig的CUA表明IVIg治疗不划算,另一个将IVIg与SCIg进行比较的CUA发现,基于家庭的SCIg比IVIg更具成本效益,但两项研究都有严重的局限性.
    结论:我们的综述强调了文献中的关键空白:血液系统恶性肿瘤患者使用Ig的成本-效果非常不确定。尽管在全球范围内使用Ig,关于治疗的直接和间接总成本的数据有限,Ig的最佳使用以及对医疗保健资源使用和成本的下游影响仍不清楚。鉴于缺乏关于Ig治疗在这一人群中的成本和成本效益的证据,进一步的卫生经济研究是必要的。
    OBJECTIVE: Patients with hematological malignancies are likely to develop hypogammaglobulinemia. Immunoglobulin (Ig) is commonly given to prevent infections, but its overall costs and cost-effectiveness are unknown.
    METHODS: A systematic review was conducted following the PRISMA guidelines to assess the evidence on the costs and cost-effectiveness of Ig, administered intravenously (IVIg) or subcutaneously (SCIg), in adults with hematological malignancies.
    RESULTS: Six studies met the inclusion criteria, and only two economic evaluations were identified; one cost-utility analysis (CUA) of IVIg versus no Ig, and another comparing IVIg with SCIg. The quality of the evidence was low. Compared to no treatment, Ig reduced hospitalization rates. One study reported no significant change in hospitalizations following a program to reduce IVIg use, and an observational study comparing IVIg with SCIg suggested that there were more hospitalizations with SCIg but lower overall costs per patient. The CUA comparing IVIg versus no Ig suggested that IVIg treatment was not cost-effective, and the other CUA comparing IVIg to SCIg found that home-based SCIg was more cost-effective than IVIg, but both studies had serious limitations.
    CONCLUSIONS: Our review highlighted key gaps in the literature: the cost-effectiveness of Ig in patients with hematological malignancies is very uncertain. Despite increasing Ig use worldwide, there are limited data regarding the total direct and indirect costs of treatment, and the optimal use of Ig and downstream implications for healthcare resource use and costs remain unclear. Given the paucity of evidence on the costs and cost-effectiveness of Ig treatment in this population, further health economic research is warranted.
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