CAG治疗老年急性髓细胞白血病疗效和安全性的Meta分析

Efficacy and safety of CAG regimen in elderly patients with acute myeloid leukemia:a Meta-analysis

目的:系统评价阿糖胞苷+阿柔比星+重组人粒细胞集落刺因子(CAG)方案与蒽环类药物联合+阿糖胞苷(3+7方案)对老年急性髓系白血病(AML)的治疗效果和相关不良反应。方法:计算机检索Cochrane Library、Ovid、Embase、PubMed、中国期刊全文数据库(CNKI)、万方数据库(Wanfang)、中文科技期刊数据库(VIP)和中国生物医学文献数据库(CBM)等电子数据库,查询CAG方案与3+7方案治疗老年AML的随机对照试验(RCT),检索时限为从建库至2018年2月。对纳入标准的RCT,由2位评价员按照Cochrane系统评价的方法,独立进行资料提取、质量评价并交叉核对后,RevMan 5.3进行Meta分析。结果:纳入的8篇文献中,共有465例患者。试验组采用CAG方案,对照组采用3+7方案。Meta分析结果显示,2种方案相比较,CAG组治疗老年AML患者的完全缓解率更高(OR=1.47,95%CI 1.01～2.12,P=0.04),部分缓解率差异无统计学意义(P=0.57),总有效率高(OR=1.74,95%CI1.17～2.60,P=0.007);不良反应方面,CAG治疗组Ⅲ/Ⅳ级血小板减少(OR=0.42,95%CI 0.24～0.75,P=0.003)、Ⅲ/Ⅳ级白细胞减少(OR=0.27,95%CI 0.13～0.52,P=0.001)、感染(OR=0.22,95%CI0.12～0.39,P<0.000 01)、肝功能损伤(OR=0.31,95%CI 0.11～0.86,P=0.02)、恶心呕吐(OR=0.09,95%CI0.05～0.18,P<0.000 01)、出血(OR=0.61,95%CI0.35～1.08,P=0.09)发生率低于3+7方案。结论:现有研究证据显示,CAG方案较3+7方案治疗老年AML具有较好疗效,且Ⅲ/Ⅳ级血小板减少、Ⅲ/Ⅳ级白细胞减少、感染、肝功能损伤、恶心呕吐、出血的发生率较低。

Objective:To systematically evaluate the efficacy and safety of G-CSF,cytarabine and aclarubicin(CAG regimen)in elderly patients with acute myeloid leukemia(AML).Method:Randomized controlled trials(RCTs)on CAG with cytarabine+ anthracycline in the treatment of AML were searched from databases of PubMed,Embase,Ovid,Cochrane Library,CNKI,VIP,WanFang Data and CBM from inception to Feb,2018.Two reviewers independently screened literature,extracted data and assessed methodological quality.RevMan 5.3 software was used for the Meta-analysis.Result:A total of 8 RCTs involving 465 patients were finally included.The trial group was given CAG while the control group was given cytarabine+anthracycline.The results of Meta-analysis showed that for elderly patients with AML,CAG produced a better complete remission rate(OR=1.47,95%CI1.01 to 2.12,P=0.04)and a better total effective rate(OR=1.74,95%CI 1.17 to 2.60,P=0.007)than control group,and there was no significant difference of partial remission rate between two groups(P>0.05).In terms of adverse events,the incidence of gradeⅢ orⅣthrombocytopenia(OR=0.42,95%CI 0.24 to 0.75,P=0.003),grade Ⅲ or Ⅳ leukocytopenia(OR=0.27,95%CI 0.13 to 0.52,P=0.001),infection(OR=0.22,95%CI0.12 to 0.39,P<0.000 01),liver function damage(OR=0.31,95%CI 0.11 to 0.86,P=0.02),nausea and vomiting(OR=0.09,95%CI 0.05 to 0.18,P<0.000 01),hemorrhage(OR=0.61,95%CI 0.35 to 1.08,P=0.09)in CAG group was significantly lower than those in control group.Conclusion:Current evidence suggests that CAG regimen could achieve a higher complete remission and total effective rate in elderly patients with AML,while the incidence of grade Ⅲ or Ⅳ thrombocytopenia,grade Ⅲ or Ⅳ leukocytopenia,infection,liver function damage,nausea and vomiting and hemorrhage are lower.