Document Detail

High-dose chemotherapy followed by autologous stem cell transplantation as first-line therapy in aggressive non-Hodgkin's lymphoma: a meta-analysis.
MedLine Citation:
PMID:  14607760     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND OBJECTIVES: High-dose chemotherapy followed by autologous stem cell transplantation (HDT/ASCT) has proven to be superior to conventional chemotherapy in patients with chemosensitive relapse of aggressive non-Hodgkin's lymphoma (NHL). Therefore, HDT/ASCT was evaluated as part of first-line therapy. Several trials generated conflicting results. This meta-analysis summarizes the available evidence from all suitable studies. DESIGN AND METHODS: Prospective, randomized trials with HDT/ASCT as first-line therapy of aggressive lymphoma were included in this meta-analysis. The primary outcome was overall mortality. Statistical analysis applied the odds ratio (OR) and a fixed effects model. RESULTS: Eleven trials with 2228 patients were eligible for meta-analysis. Overall mortality was comparable in the HDT/ASCT and in control arms (OR=0.97, 95% CI: 0.69;1.36, p=0.9), with statistically significant heterogeneity between the trials. To resolve this, we tried to identify variables that could explain this heterogeneity. Among a range of methodological, patient- or treatment-related factors, subgroups formed by the proportion of bulky disease in treated patients, the type of therapy prior to HDT/ASCT, the drop-out rate from the HDT/ASCT arm, and the presence of high or high-intermediate risk IPI showed significant benefit for any of the treatment modalities. However, such post-hoc subgroup analysis may be considerably influenced by random or systemic biases. INTERPRETATION AND CONCLUSIONS: Overall, the analysis of published evidence reveals very heterogeneous results and no overall survival benefit. Therefore, HDT/ASCT cannot be recommended as standard first line treatment for patients with aggressive NHL. However, the exploratory analyses presented here may help to design new trials for this treatment modality.
John Strehl; Ulrich Mey; Axel Glasmacher; Benjamin Djulbegovic; Christine Mayr; Marcus Gorschlüter; Carsten Ziske; Ingo G H Schmidt-Wolf
Publication Detail:
Type:  Journal Article; Meta-Analysis    
Journal Detail:
Title:  Haematologica     Volume:  88     ISSN:  1592-8721     ISO Abbreviation:  Haematologica     Publication Date:  2003 Nov 
Date Detail:
Created Date:  2003-11-10     Completed Date:  2004-02-24     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0417435     Medline TA:  Haematologica     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  1304-15     Citation Subset:  IM    
Medizinische Klinik und Poliklinik I der Rheinischen Friedrich-Wilhelms-Universität Bonn, Germany.
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MeSH Terms
Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
Combined Modality Therapy
Lymphoma, Non-Hodgkin / drug therapy*,  mortality,  therapy
Middle Aged
Peripheral Blood Stem Cell Transplantation*
Prospective Studies
Randomized Controlled Trials as Topic
Survival Analysis
Transplantation Conditioning
Transplantation, Autologous
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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