This network meta-analysis (NMA) was conducted to integrate different chemotherapeutic regimens for non-Hodgkin lymphoma (NHL) patients. Overall survival (OS) and complete remission (CR) were considered as main outcome indicators to evaluate the efficacy of NHL chemotherapies. OS and CR data were extracted from included studies and represented by hazard ratio and odds ratio separately. Network structure and forest plots were further included to visually present the relative efficacy among different regimens. A total of 14 qualified publications with 4,167 patients were included. In OS results, no significant difference was observed from the 1-year OS. For 2-year, 3-year and 5-year OS, patients treated by CNOP exhibited the least favorable results. Moreover, significant advantages of R-CHOP treatment over CHOP and VMP were recognized in view of 3-year OS. In respect of CR, R-HDS presented significantly better outcomes than CNOP and VMP, and no significant difference was identified when compared to CHOP in forest plot. ProMACE-CytaBOM and R-HDS possessed the compelling cumulative ranking probability in OS or CR, indicating their competitive performance in NHL treatment while R-CHOP and I-CHOP yielded desirable in terms of long-term survival and short-term survival, respectively. To conclude, ProMACE-CytaBOM, I-CHOP, R-HDS and R-CHOP were recommended to go through further evaluation to confirm their superiority in NHL treatment. CNOP and VMP were discouraged after comprehensively analyzing OS and CR from NMA results.
Antecedentes: El linfoma agresivo no Hodgkin (LNH) representa aproximadamente el 60% de los linfomas en el Oeste y aún más en el mundo en desarrollo. ciclofosfamida, doxorrubicina, vincristina y prednisona (CHOP) es reconocido como el régimen estándar de quimioterapia y la adición de rituximab a los subtipos de células B se ha demostrado que mejora significativamente los resultados del tratamiento. No obstante, todavía una fracción significativa de los pacientes no se ofrece rituximab debido a razones económicas. Así, CHOP todavía se ofrece a estos pacientes así como aquellos con células T subtipos. Los datos de la década de 1990 han indicado que la intensidad de la dosis (DI) de la doxorubicina es un factor clave en la predicción de la supervivencia.
MÉTODOS: Una búsqueda en MEDLINE y Cochrane biblioteca se llevó a cabo utilizando "CHOP" los términos de búsqueda, el linfoma 'y' de los ensayos aleatorios. Los ensayos elegibles habían CHOP como un brazo de control y de cualquier régimen de la administración de doxorubicina en una mayor DI (16,6 mg / m (2) / semana) como el brazo de investigación. El agrupamiento de los datos se llevó a cabo utilizando el modelo de efectos mixtos.
RESULTADOS: Ocho ensayos fueron elegibles. Los pacientes tratados con doxorubicina DI regímenes basados tuvieron una supervivencia global significativamente mejor ratio [RESUMEN DE RIESGOS (SHR) 0,82, IC del 95% intervalo de confianza (IC) 0,71-0,96], supervivencia libre de eventos (SHR 0,86, IC 95% 0.75 a 0.99) y mayor tasa de respuesta completa (resumen odds ratio: 0.91, IC 95% 0.67-0.97).
CONCLUSIÓN: DI de alta basado en doxorubicina debe ser considerada en pacientes con LNH agresivo.
This network meta-analysis (NMA) was conducted to integrate different chemotherapeutic regimens for non-Hodgkin lymphoma (NHL) patients. Overall survival (OS) and complete remission (CR) were considered as main outcome indicators to evaluate the efficacy of NHL chemotherapies. OS and CR data were extracted from included studies and represented by hazard ratio and odds ratio separately. Network structure and forest plots were further included to visually present the relative efficacy among different regimens. A total of 14 qualified publications with 4,167 patients were included. In OS results, no significant difference was observed from the 1-year OS. For 2-year, 3-year and 5-year OS, patients treated by CNOP exhibited the least favorable results. Moreover, significant advantages of R-CHOP treatment over CHOP and VMP were recognized in view of 3-year OS. In respect of CR, R-HDS presented significantly better outcomes than CNOP and VMP, and no significant difference was identified when compared to CHOP in forest plot. ProMACE-CytaBOM and R-HDS possessed the compelling cumulative ranking probability in OS or CR, indicating their competitive performance in NHL treatment while R-CHOP and I-CHOP yielded desirable in terms of long-term survival and short-term survival, respectively. To conclude, ProMACE-CytaBOM, I-CHOP, R-HDS and R-CHOP were recommended to go through further evaluation to confirm their superiority in NHL treatment. CNOP and VMP were discouraged after comprehensively analyzing OS and CR from NMA results.
