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20.04.2022 | Original Article

Comparative efficacy and safety of eleven induction chemotherapy regimens for young adult patients with newly diagnosed acute myeloid leukemia: a network meta-analysis

verfasst von: Yiqing Li, Ting Tang, Jie Xiao, Boqi Li, Wenjuan Yang, Shuangfeng Xie, Yumo Du, Kezhi Huang, Danian Nie

Erschienen in: Annals of Hematology | Ausgabe 7/2022

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Abstract

The optimal induction chemotherapy regimens for young adult patients with newly diagnosed acute myeloid leukemia (AML) are not well-defined since the lack of direct comparisons between emerging treatments. Network meta-analysis (NMA) is a statistical tool to integrate direct and indirect evidence to evaluate the effect of multiple interventions. Thus, we conducted an NMA to systematically assess the efficacy and safety of different inductions for these patients. PubMed, Embase, Cochrane Library, and Web of Science were searched from establishment to 2020–03-11. Randomized controlled trials (RCTs) using different inductions were included. We deemed 11 trials eligible, including 11 inductions with 5052 participants. Relative risk (RR) and 95% confidence intervals (CIs) were calculated. In terms of complete remission (CR) rate, DAC ranked highest and was significantly higher than IA (RR = 1.27, 95% CI (1.09–1.48)) and DA (RR = 1.28, 95% CI (1.13–1.46)) (p < 0.05). The ranking of DA + Pioglitazone was second only to that of DAC, followed by HAA. For early mortality, HAD, HAA, and DA + GO were significantly higher than DA/IA (p < 0.05). DAC and DA + Pioglitazone showed similar early mortality compared to DA/IA (p > 0.05). Regarding incidence of early grade 3–4 infection, no significant differences between interventions were observed. To conclude, among the included 11 induction regimens, DAC was potentially the top choice for young adult patients with newly diagnosed AML, with highest CR rate, low early mortality, and incidence of early infection. DA + Pioglitazone and HAA also showed a superiority over the others to achieve higher CR rate, while caution should be kept in mind due to the higher early mortality of HAA.
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Fußnoten
1
CR refers to meeting the following three criteria: (1)no leukemia related clinical symptoms such as anemia, hemorrhage, infections; (2) neutrophil ≥ 1.5 × 109/L, hemoglobin ≥ 90 g/L, platelet ≥ 100 × 109/L; (3) regeneration of normal erythrocyte and megakaryocyte maturation with blasts less than 5% in the bone marrow.
 
2
According to the evaluation criterion of common adverse events following chemotherapy (CTCAE) published by the United States Department of Health and Human Services (HHS), or the toxicity classification of chemotherapy by WHO.
 
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Metadaten
Titel
Comparative efficacy and safety of eleven induction chemotherapy regimens for young adult patients with newly diagnosed acute myeloid leukemia: a network meta-analysis
verfasst von
Yiqing Li
Ting Tang
Jie Xiao
Boqi Li
Wenjuan Yang
Shuangfeng Xie
Yumo Du
Kezhi Huang
Danian Nie
Publikationsdatum
20.04.2022
Verlag
Springer Berlin Heidelberg
Erschienen in
Annals of Hematology / Ausgabe 7/2022
Print ISSN: 0939-5555
Elektronische ISSN: 1432-0584
DOI
https://doi.org/10.1007/s00277-022-04840-9

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