RESPONSE: Re: Consolidation Therapy With Autologous Bone Marrow Transplantation in Adults With Acute Myeloid Leukemia: A Meta-analysis
Notice bibliographique
Résumé
In their letter to the Journal, as well as in their meta-analysis ( 1 ) , Levi et al. contend that a decline in the treatment-related mortality associated with the use of peripheral blood stem cells instead of bone marrow for autologous transplantation supports the routine use of autologous stem cell transplantation (ASCT) in adults with acute myeloid leukemia in first remission. Although we agree that this strategy warrants further study in a prospective, randomized clinical trial, we have several concerns about the assumptions that the authors have made in order to reach their conclusions. First, the simulations presented by Levi et al. assume that improvements in supportive care and the development of safer transplant techniques have decreased treatment-related mortality among patients who receive an ASCT. The simulations do not account for improvements in survival as a result of better supportive care in patients who receive chemotherapy alone. Such a decrease in treatment-related mortality over time, for example, was observed among children who were treated with chemotherapy alone on the Tenth Medical Research Council Acute Myeloid Leukaemia Trial (MRC AML 10) ( 2 ). The authors’ supposition that treatment-related mortality has decreased only among transplant recipients biases their analysis in favor of ASCT. In our meta-analysis, we noted that the pooled treatment-related mortality among patients who were randomly assigned to receive chemotherapy (or no further treatment) was 4.4% ( 3 ). The authors’ assumption of a 3% treatment-related mortality in the ASCT arm of their second simulation suggests that ASCT results in a lower risk of treatment-related mortality than chemotherapy alone—a contention that is not supported by the available literature. Second, the authors’ assertion that the treatment-related mortality among patients receiving ASCT is currently 0%–6% is based on data from patients who actually received ASCT ( 4 ). However, such an analysis by treatment received is biased in favor of ASCT. Patients who actually undergo transplantation will have better outcomes when compared with all patients randomly assigned to receive transplantation because some of the latter patients will relapse or die before receiving the procedure or will be too ill to proceed to transplantation. Therefore, an intent-to-treat analysis is more appropriate for comparing transplantation with chemotherapy than an analysis by treatment received. Both the original meta-analysis published by Levi et al. ( 1 ) and our meta-analysis ( 3 ) based calculations of survival on intent-to-treat analyses. In the absence of data from a randomized clinical trial, it is impossible to know whether a decrease in mortality among patients who receive peripheral blood stem cells is attributable to a true reduction in treatment-related mortality or, at least in part, to the use of an analysis of only patients who received the treatment. Third, the formula used by Levi et al. to calculate the expected deaths in the ASCT arm is unconventional. We urge the authors to clarify their calculations and provide a reference for their approach. Although we agree that the role of ASCT among patients in first remission of acute myeloid leukemia warrants further study, we caution against drawing conclusions by combining the results of previous randomized studies of autologous bone marrow transplantation with estimates of survival of ASCT derived from current single-arm studies.
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 | 0,009 | 0,043 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,005 | 0,009 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,003 |
| Science ouverte | 0,003 | 0,002 |
| Intégrité de la recherche | 0,011 | 0,008 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,042 | 0,010 |
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 ».