PS1466 CYTOREDUCTION FOR THE TREATMENT OF ESSENTIAL THROMBOCYTHEMIA: A SYSTEMATIC REVIEW
Notice bibliographique
Résumé
Background: Cytoreductive therapies are recommended in patients with essential thrombocythemia (ET) to prevent arterial and venous thrombosis. Aims: The aim of this study was to systematically review the benefits and harms of different cytoreductive therapies in adult patients diagnosed with ET. Methods: We searched MEDLINE, EMBASE, FDA, and EMA databases from inception through 23 January 2017 for randomized trials and prospective observational studies in English evaluating first‐line cytoreduction in ET patients diagnosed by WHO or PVSG criteria. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool for randomized controlled trials, and the MINORS criteria for observational studies. Results: We found 34 studies involving 6791 participants: 3 randomized controlled trials (RCT), and 31 prospective observational studies. In the single trial comparing hydroxyurea versus placebo, hydroxyurea reduced arterial thromboembolism (ATE) (RR 0.13 [95%CI 0.03–0.54]) and venous thromboembolism (VTE) (RR 0.52 [95%CI 0.05–5.55]), increased transformation to MDS or AML (RR 9.32 [95%CI 0.51–169.13]), with no difference in mortality (RR 1.09 [95%CI 0.45–2.62]). In a trial from 2013, Anagrelide was non‐inferior to hydroxyurea in ET‐related major and minor thrombohemorrhagic events (HR 0.92 [95% CI, 0.57–1.46] at 36 months). There were no reported events of disease progression to myelofibrosis (MF) or secondary leukemia. In an RCT from 2007 comparing anagrelide plus aspirin and hydroxyurea plus aspirin, anagrelide was associated with increased rates of arterial thrombosis (p = 0.004), serious hemorrhage (p = 0.0008), and transformation to MF (p = 0.01). However, there was a decreased rate of venous thromboembolism (VTE) (p = 0.006). Observational studies evaluated the cytoreductive therapies anagrelide (n = 1930), hydroxyurea (n = 898), interferon alpha (n = 453), and pipobroman (n = 270). Overall, of patients treated with anagrelide, there was 6.3% all‐cause mortality, 0.7% VTE, 3.3% ATE, and 5.5% major bleeding complications. Rates of transformation were 3.3% to MF, 0.3% to acute myeloid leukemia (AML), and 0.1% to myelodysplastic syndrome (MDS). In patients treated with hydroxyurea, there was 5.8% all‐cause mortality, 4.3% VTE, 3.8% ATE, and 4.8% major bleeding. Rates of transformation were 0.8% to MF, 1.2% to AML and 0.5% to MDS. Patients treated with interferon alpha had 2.5% all‐cause mortality, 5.4% VTE, 0.6% ATE, and 2.0% major bleeding. Rates of transformation were 4.2% to MF, 1.1% to AML, and no reported transformation to MDS. Of patients treated with pipobroman, there was 15.3% all‐cause mortality, 2.9% VTE, 7.2% ATE, and 1.2% major bleeding. Rates of transformation were 0.7% to MF, 2.6% to AML, and 0.7% to MDS. In patients who did not receive any cytoreductive therapy, all‐cause mortality was 15.5%, with 6.0% VTE, no reported ATE, and 6.9% major bleeding. There were no cases of transformation to MF, AML, or MDS. Most observational studies were at high risk of bias due to lack of adjustment for potential confounders. Summary/Conclusion: In patients with ET, hydroxyurea may reduce ET‐related thrombotic events compared to placebo. A single randomized controlled trial and low quality observational data may suggest that anagrelide has decreased rates of venous thromboembolism and increased rates of arterial thromboembolism, hemorrhage, and transformation to myelofibrosis compared to hydroxyurea. However, all studies had significant risk of bias with critical implications for guideline recommendations and the need for new research.
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 distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,006 | 0,002 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 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 tête enseignante, 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 ».