Role of upfront autologous stem cell transplantation (ASCT) in adults with T‐NHL in first complete remission (CR1): A systematic literature review and meta‐analysis
Notice bibliographique
Résumé
Introduction: There is currently no consensus on the role of upfront ASCT for patients with T cell Non-Hodgkin lymphomas (T-NHL), especially in patients who have achieved complete remission (CR1) following induction chemotherapy. To date, no randomized control trials (RCTs) exist and available data is conflicting, especially with regards to T-NHL subtypes that might benefit. A systematic review and meta-analysis of all comparative studies (randomized, non-randomized and observational) was hence performed to address this question. Methods: A comprehensive, systematic search (from 1/2000 to 2/2022) of MEDLINE/PubMed, EMBASE and Cochrane databases was performed. PRISMA and Meta-Analysis Of Observational Studies in Epidemiology (MOOSE) guidelines were followed. Studies were screened based on predefined inclusion/exclusion criteria, and were critically appraised for outcomes of interest [progression free survival (PFS) and overall survival (OS)]. Quality of studies was assessed using Newcastle-Ottawa Scale. Hazard ratios (HRs) and corresponding 95% Cis were calculated, and the meta-analysis was performed using the random-effects model. Test for heterogeneity was performed using I2 statistic. Results: Of 3297 unique records, 17 studies (prospective = 6, retrospective = 11) were included. Median follow up in these studies ranged from 22 to 94 mths. Ten studies compared upfront ASCT versus No ASCT in patients with complete remission (CR1), while in 7 patients achieving either PR1 (first partial remission) or CR1 were included[MS1]. Of these, 9 studies included only transplant eligible patients. The T-NHL subtypes included in the studies were also heterogenous, with nodal T-NHLs, in particular Angioimmunoblastic T-NHL (AITL) being amongst the most common subtypes. Results: from the meta-analysis showed that PFS in T-NHL patients who underwent ASCT benefited (HR 0.64, 95% CI: 0.46–0.89, I2 = 74%) compared to not undergoing ASCT; however similar benefit was not observed in OS (HR 0.67, 95% CI: 0.36–1.23, I2 = 89%). Sensitivity analyses including only studies with patients transplanted in CR1, and studies involving transplant eligible patients showed similar findings. In the studies that evaluated patients with the AITL subtype, ASCT showed a significant benefit in PFS and OS, compared to not undergoing ASCT (PFS = HR 0.19, 95% CI: 0.11–0.32, I2 20%; OS = HR 0.27, 95% CI: 0.09–0.81, I2 88 (Figure 1). Keyword: stem cell transplant No conflicts of interests pertinent to the abstract.
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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) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,003 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| 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 ».