非清髓异基因造血干细胞移植治疗已完成一次自体造血干细胞移植后的多发性骨髓瘤疗效和安全性的系统评价

Non-myeloablative Stem Cell Transplantation in the Treatment of Multiple Myeloma after First Autologous Stem Cell Transplantation: A Systematic Review

目的系统评价非清髓异基因造血干细胞移植(NST)对已完成一次自体造血干细胞移植后的多发性骨髓瘤的疗效和安全性。方法计算机检索h e Cochrane Library(2013年第5期)、PubMed、EMbase、CBM、CNKI、VIP和WanFang Data等数据库,收集NST方案与非NST方案治疗已完成一次自体造血干细胞移植的多发性骨髓瘤效果的比较研究。检索时限均从建库至2013年6月13日。由2名评价员按纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan5.1软件进行Meta分析。结果共纳入7个研究,包括1961例患者,其中NST组626例,非NST组1335例。Meta分析结果显示:与非NST方案相比,NST方案在完全缓解率[RR=1.29,95%CI(1.13,1.48),P=0.0002]和治疗相关死亡率[RR=3.40,95%CI(2.27,5.07),P<0.000 01]方面差异有统计学意义,但在总生存率[HR=1.06,95%CI(0.78,1.44),P=0.69]和无进展生存率[HR=0.92,95%CI(0.76,1.11),P=0.39]方面,两者差异无统计学意义。结论 NST方案较非NST方案对已完成一次自体造血干细胞移植的多发性骨髓瘤患者的疗效未见显著提高。因此目前证据尚不足以推荐NST作为已完成一次自体造血干细胞移植的多发性骨髓瘤患者的首选治疗方案。

Objective To systematically review the efficacy and safety of non-myeloablative stem cell transplanta- tion （NST） for the treatment of multiple myeloma （MM） after first autologous stem cell transplantation. Methods Such databases as The Cochrane Library （Issue 5, 2013）, PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were elec- tronically searched to collect studies investigated the efficacy and safety of NST and non-NST for the treatment of MM after first autologous stem cell transplantation from the date of their establishment to June 13th 2013. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the meth- odological quality of the included studies. Then meta-analysis was performed using RevMan 5.1 software. Results Seven studies involving 1 961 participants were included, of which 626 cases were in the NST group and 1 335 cases were in the non-NST group. The results of meta-analysis showed that no significant difference was found between both groups in the overall survival rate （HR=1.06, 95%CI 0.78 to 1.44, P=0.69） and progress-free survival rate （HR=0.92, 95%CI 0.76 to 1.11, P=0.39）. However, there were significant differences in the complete remission rate （RR=1.29, 95%CI 1.13 to 1.48, P=0.000 2） and treatment-related mortality rate （RR=3.40, 95%CI 2.27 to 5.07, P〈0.000 01）. Conclusion The efficacy of NST is not superior to non-NST for patients with MM which has received first autologous stem cell transplantation. It is not sufficient to recommend NST as the first-line treatment of MM based on the currently available evidence.