| High-dose chemotherapy followed by autologous stem cell transplantation as first-line therapy in aggressive non-Hodgkin's lymphoma: a meta-analysis. | |
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MedLine Citation:
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PMID: 14607760 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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John Strehl; Ulrich Mey; Axel Glasmacher; Benjamin Djulbegovic; Christine Mayr; Marcus Gorschlüter; Carsten Ziske; Ingo G H Schmidt-Wolf |
Publication Detail:
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Type: Journal Article; Meta-Analysis |
Journal Detail:
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Title: Haematologica Volume: 88 ISSN: 1592-8721 ISO Abbreviation: Haematologica Publication Date: 2003 Nov |
Date Detail:
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Created Date: 2003-11-10 Completed Date: 2004-02-24 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0417435 Medline TA: Haematologica Country: Italy |
Other Details:
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Languages: eng Pagination: 1304-15 Citation Subset: IM |
Affiliation:
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Medizinische Klinik und Poliklinik I der Rheinischen Friedrich-Wilhelms-Universität Bonn, Germany. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Antineoplastic Combined Chemotherapy Protocols / therapeutic use* Combined Modality Therapy Female Humans Lymphoma, Non-Hodgkin / drug therapy*, mortality, therapy Male 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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