骨髓增生异常综合征患者移植前不同方案治疗对移植后结局影响的Meta分析

Effects of different treatment regimens before allogeneic-hematopoietic stem cell transplantation on the outcome after transplantation of patients with myelodysplastic syndrome:a meta analysis

目的系统性评价骨髓增生异常综合征(MDS)患者在异基因造血干细胞移植(allo-HSCT)前接受不同治疗方案对移植后长期复发及生存的影响。方法检索Ovid、Cochrane Library、PubMed、Embase、中国期刊全文数据库、中文科技期刊数据库、万方数据库和中国生物医学文献数据库中从建库至2019年12月MDS患者行allo-HSCT前接受不同方案治疗的文献。对符合纳入标准的文献,由2名研究者按Cochrane系统评价方法,独立进行资料提取、质量评价并交叉核对。按治疗方法,将纳入文献中的病例分为去甲基化药物(地西他滨或阿扎胞苷)治疗组(去甲基化治疗组)和传统方案治疗组(包括化疗和支持治疗)(传统治疗组)。采用RevMan 5.3软件对各组总生存(OS)、复发、无复发死亡率(NRM)、无复发生存(RFS)进行分析。结果共纳入10篇文献。Meta分析结果显示,传统治疗组中,化疗组与支持治疗组间3年OS率[44.6%(146/327)比35.5%(138/389);OR=0.93,95%CI 0.38~2.27,P=0.87]、复发率[32.4%(106/327)比37.3%(145/389);OR=1.00,95%CI 0.49~2.05,P=0.99]、NRM[26.3%(86/327)比27.0%(105/389);OR=1.05,95%CI 0.75~1.49,P=0.77]、RFS率[9.2%(30/327)比12.6%(49/389);OR=0.74,95%CI 0.26~2.10,P=0.57]差异均无统计学意义。去甲基化治疗组与传统治疗组间3年OS率[40.7%(165/405)比45.9%(290/632);OR=0.98,95%CI 0.71~1.36,P=0.28]、复发率[32.6%(132/405)比38.3%(242/632);OR=1.05,95%CI 0.79~2.05,P=0.25]、NRM[27.2%(110/405)比24.8%(157/632);OR=0.81,95%CI 0.59~1.11,P=0.68]、RFS率[46.7%(189/405)比42.2%(267/632);OR=0.84,95%CI 0.63~1.12,P=0.85]差异均无统计学意义。无论去甲基化治疗组与化疗组间、还是去甲基化治疗组与支持治疗组间,3年OS率、复发率、NRM、RFS率差异均无统计学意义(均P>0.05)。结论MDS患者allo-HSCT前接受不同方案治疗对于移植后生存和复发均无明显影响。

Objective To systematically evaluate effects of different treatment schemes before allogeneic-hematopoietic stem cell transplantation(allo-HSCT)on the long-term relapse and survival of patients with myelodysplastic syndrome(MDS)after transplantation.Methods The related literatures were searched from databases of Ovid,Cochrane Library,PubMed,Embase,CNKI,VIP,WanFang and CBM from inception to December 2019.And then 2 reviewers independently extracted data,assessed methodological quality and crosschecked on the included literatures.According to the treatment methods,the cases included in the literatures were divided into demethylation drug(decitabine or azacytidine)treatment(demethylation treatment group)and traditional treatment regimen(including chemotherapy and support treatment)(traditional treatment group).RevMan 5.3 software was used to analyze overall survival(OS),recurrence,non-relapse mortality(NRM)and relapse free survival(RFS).Results Finally,10 articles were included.The results of meta-analysis showed that in the traditional treatment group,the differences of 3-year OS rate[44.6%(146/327)vs.35.5%(138/389);OR=0.93,95%CI 0.38-2.27,P=0.87],the recurrence rate[32.4%(106/327)vs.37.3%(145/389);OR=1.00,95%CI 0.49-2.05,P=0.99],NRM[26.3%(86/327)vs.27.0%(105/389);OR=1.05,95%CI 0.75-1.49,P=0.77],RFS rate[9.2%(30/327)vs.12.6%(49/389);OR=0.74,95%CI 0.26-2.10,P=0.57]between the chemotherapy group and the support treatment group were not statistically significant.The differences of 3-year OS rate[40.7%(165/405)vs.45.9%(290/632);OR=0.98,95%CI 0.71-1.36,P=0.28],recurrence rate[32.6%(132/405)vs.38.3%(242/632);OR=1.05,95%CI 0.79-2.05,P=0.25],NRM[27.2%(110/405)vs.24.8%(157/632);OR=0.81,95%CI 0.59-1.11,P=0.68],RFS rate[46.7%(189/405)vs.42.2(267/632);OR=0.84,95%CI 0.63-1.12,P=0.85]between demethylation treatment group and traditional treatment group were not statistically significant.There were no significant differences in 3-year OS rate,recurrence rate,NRM and RFS rate between demethylation treatment group and chemotherapy group,demethylation treatment group and support treatment group(all P>0.05).Conclusion Different treatment regimens before allo-HSCT have no significant effect on survival or recurrence after transplantation for patients with MDS.