Is There Difference between the Survival Rate and Treatment Related Complications between Peripheral Blood Stem Cell Transplantation and Bone Marrow Transplantation for Pediatric Hematological Malignancy?: Systematic Review and Meta-Analysis
Notice bibliographique
Résumé
Abstract Background: As a source of cells for hematopoietic cell transplantation (HCT), peripheral blood stem cells (PBSC) have become a major alternative to bone marrow, the most common source of cells. A meta-analysis showed that the use of PBSC in adults is not superior with respect to overall survival, and the incidence of chronic graft-versus-host disease (GVHD) is more frequent after PBSC transplantation (PBSCT) than after bone marrow transplantation (BMT). Furthermore, several studies suggested that PBSCT in children results in poor overall survival compared with BMT, and the benefit of PBSCT is controversial. To elucidate this question, we conducted a systematic review and meta-analysis to compare the survival rate and treatment related complications of pediatric patients receiving PBSCT with those receiving BMT. Methods: Based on the pre-defined protocol, MEDLINE, EMBASE plus EMBASE classics, Cochrane Central Register of Controlled Trials, the International Clinical Trials Registry Platform Search Portal and Clinical Trials.gov records were searched from inception through July 25, 2018 with no language restriction. The search terms included "hematopoietic stem cell transplantation" AND "allogeneic transplantation" AND "children". We included randomized control studies or cohort studies. The Newcastle-Ottawa Quality Assessment Scale was used to evaluate study quality. The primary outcome was to evaluate five-year overall survival after HCT. Secondary outcomes were five-year event-free survival after HCT, non-relapse mortality, the incidence of acute and chronic GVHD, and time to platelet and neutrophil engraftment. We performed meta-analyses using random effect models with risk ratios (RR) and a 95% confidence interval (CI). Heterogeneity was assessed using the I-squared statistic and chi-squared test. Publication bias was assessed with funnel plots. Results: We identified a total of 5,248 relevant studies. Seven cohort studies with a total of 4,328 patients (BMT group 3,185 patients and PBSCT group 1,143 patients) were included in the present study. There was no significant difference between PBSCT and BMT for five-year overall survival (RR: 1.17, 95% CI: 0.91-1.52, heterogeneity I2=69%, p=0.22) and five year event free survival (RR: 1.14, 95% CI: 0.93-1.39, heterogeneity I2=57%, p=0.05), respectively. The risk of chronic GVHD in the PBSCT group was higher than those in the BMT group (RR: 1.65, 95% CI: 1.18-2.03, heterogeneity I2=75%, p=0.002). The risk of non-relapse mortality with PBSCT was higher than with BMT (RR: 1.73, 95% CI: 1.50-1.99, heterogeneity I2=0%, p<0.00001), and the relapse rate did not show a significant difference between BMT and PBSCT (RR:1.26, 95% CI: 0.94-1.69, heterogeneity I2=71%, p=0.004). Conclusions: This meta-analysis did not show significant difference in overall survival or relapse between PBSCT and BMT for pediatric hematological malignancy. However, a higher risk of chronic GVHD and transplantation related mortality was associated with PBSCT. Table. Table. Disclosures No relevant conflicts of interest to declare.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,011 | 0,031 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,018 | 0,035 |
| Bibliométrie | 0,006 | 0,008 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».