含照射与纯化疗的移植预处理方案治疗儿童白血病:Meta分析

Comparison of Total Body Irradiation(TBI) with Cyclophosphamide Versus Bulsulphan withCyclophosphamide as Conditioning for Children with Leukemia Disease:A Meta-Analysis

目的观察含照射与纯化疗的两种不同的移植预处理方案对儿童造血干细胞移植的治疗效果。方法计算机检索循证医学数据库、美国国立医学图书馆医学文献分析和联机检索系统、中国学术期刊网全文数据库、中国生物医学文献光盘数据库在199042007年期间发表的关于儿童白血液病移植中对比不同预处理方案的研究文献。从干细胞植入、移植后的治疗相关病死率、长期生存率等方面进行对比分析。采用Review Manager软件进行Meta分析。结果检索出4012篇文献，最终纳入9个试验共2333例患者。全身照射加环磷酰胺与白消安加环磷酰胺组相比植入失败率和移植后的复发率无明显区别：白消安加环磷酰胺组治疗相关病死率明显升高，而全身照射加环磷酰胺组长期无病生存率则明显优于白消安加环磷酰胺组。结论目前有限文献表明，全身照射加环磷酰胺预处理方案是儿童白血病移植的有效方案，而全身照射对儿童生长发育的长期不良影响有待进一步探讨。

Objective This study is to compare the therapeutic efficacy of total body irradiation with cyclophosphamide （TBI/CY） versus bulsulphan with cyclophosphamide （BU/ CY） as conditioning for children with leukemia disease. TBI/CY and BU/CY are standard condition regimens in hematological stem cell transplantation. Methods We electronically searched the Cochrane, MEDLINE, CNKI, Chinese Bio-medicine Database （CBM） and critica lly appraised all relevant articles（1999-2007）. Comparative studies were carried out on clinical therapeutic effects of TBI/CY and BU/CY in terms of related mortality,survival rate after stem cells engraftment and relapse. We performed a meta-analysis using Review Manager 4.2 software and adopted funnel plot regression to assess the publication bias. Results From 4 012 records,we got 9 trials totaling 2 333 patients. Pooled comparisons of studies of TBI/ CY and BU/CY in children found that the incidence of engraftment failure and recur rates were the same between the two groups. BU/CY group had much higher related mortality while TBI/CY group had a favorite long survival rate over BU/CY group. Conclusion The data show that TBI/CY condition regimen is effective to treat children with leukemia disease and the long term influence needs to be further researched.