Background. Randomised controlled trials (RCTs) reported conflicting results on the impact of high-dose chemotherapy (HDCT) and autologous stem cell transplantation in the first-line treatment of patients with aggressive non-Hodgkin Lymphoma (NHL). Aims and Methods. We performed a meta-analysis based on individual patient data (IPD) to assess the efficacy of HDCT compared to conventional chemotherapy in aggressive NHL patients with regard to overall survival (OS) and progression-free survival (PFS). Furthermore, we wanted to determine the efficacy on the intervention in specific subgroups of patients. Particularly we analysed the impact of the age-adjusted International Prognostic Index (aaIPI). We searched the Cochrane Library, MEDLINE and other databases (1/1990 to 12/2007). The RCTs were conducted mainly without Rituximab. Hazard ratios (HR) with 95% confidence intervals (CIs) were calculated using the Cox proportional hazards model stratified by study. The conventional chemotherapy-arm is taken as reference in the analysis. Results. Individual patient data were available from 11 RCTs including 2,132 randomised patients. Information on patient characteristics, treatment, events and survival was collected. Overall, there was no evidence for HDCT to improve OS (HR 1.09; 95% CI 0.95-1.24) or PFS (HR 1.04; 95% CI 0.92-1.17) when compared with conventional chemotherapy. In subgroup analysis hazard ratios for OS was 1.34 (95% CI 0.98-1.82) for good risk patients and 1.01 (95% CI 0.87-1.17) for poor risk patients (p value for interaction = 0.10). Subgroup analysis did not indicate differences in terms of PFS between good (HR 1.07, 95% CI 0.84-1.36) and poor risk (HR 0.99, 95% CI 0.87-1.14) patients (p value for interaction = 0.61). Summary and Conclusions. Preliminary analyses suggest that there is no evidence for HDCT to improve OS or PFS in NHL patients compared to conventional chemotherapy. There was no evidence for different treatment outcomes in patients with good or poor IPI risk group. Further results will be presented.

HIGH DOSE CHEMOTHERAPY WITH AUTOLOGOUS STEM CELL SUPPORT IN FIRST LINE TREATMENT OF AGGRESSIVE NON HODGKIN LYMPHOMA: RESULTS OF AN INDIVIDUAL PATIENT DATA META-ANALYSIS / C., Brillant; G., Schwarzer; J., Bohlius; A., Greb; S., Trelle; C., Haioun; A., De Souza; C., Gisselbrecht; T., Intragumtornchai; U., Kaiser; C., Kluin Nelemans; Martelli, Maurizio; N., Milpied; F., Verdonck; U., Vitolo; A., Engert; H., Schulz. - In: HAEMATOLOGICA. - ISSN 0390-6078. - 94:(2009), pp. 392-392. (Intervento presentato al convegno 14th Annual Meeting of the European-Hematology-Association tenutosi a Berlin, GERMANY nel JUN 04-07, 2009).

HIGH DOSE CHEMOTHERAPY WITH AUTOLOGOUS STEM CELL SUPPORT IN FIRST LINE TREATMENT OF AGGRESSIVE NON HODGKIN LYMPHOMA: RESULTS OF AN INDIVIDUAL PATIENT DATA META-ANALYSIS

MARTELLI, Maurizio;
2009

Abstract

Background. Randomised controlled trials (RCTs) reported conflicting results on the impact of high-dose chemotherapy (HDCT) and autologous stem cell transplantation in the first-line treatment of patients with aggressive non-Hodgkin Lymphoma (NHL). Aims and Methods. We performed a meta-analysis based on individual patient data (IPD) to assess the efficacy of HDCT compared to conventional chemotherapy in aggressive NHL patients with regard to overall survival (OS) and progression-free survival (PFS). Furthermore, we wanted to determine the efficacy on the intervention in specific subgroups of patients. Particularly we analysed the impact of the age-adjusted International Prognostic Index (aaIPI). We searched the Cochrane Library, MEDLINE and other databases (1/1990 to 12/2007). The RCTs were conducted mainly without Rituximab. Hazard ratios (HR) with 95% confidence intervals (CIs) were calculated using the Cox proportional hazards model stratified by study. The conventional chemotherapy-arm is taken as reference in the analysis. Results. Individual patient data were available from 11 RCTs including 2,132 randomised patients. Information on patient characteristics, treatment, events and survival was collected. Overall, there was no evidence for HDCT to improve OS (HR 1.09; 95% CI 0.95-1.24) or PFS (HR 1.04; 95% CI 0.92-1.17) when compared with conventional chemotherapy. In subgroup analysis hazard ratios for OS was 1.34 (95% CI 0.98-1.82) for good risk patients and 1.01 (95% CI 0.87-1.17) for poor risk patients (p value for interaction = 0.10). Subgroup analysis did not indicate differences in terms of PFS between good (HR 1.07, 95% CI 0.84-1.36) and poor risk (HR 0.99, 95% CI 0.87-1.14) patients (p value for interaction = 0.61). Summary and Conclusions. Preliminary analyses suggest that there is no evidence for HDCT to improve OS or PFS in NHL patients compared to conventional chemotherapy. There was no evidence for different treatment outcomes in patients with good or poor IPI risk group. Further results will be presented.
2009
14th Annual Meeting of the European-Hematology-Association
04 Pubblicazione in atti di convegno::04d Abstract in atti di convegno
HIGH DOSE CHEMOTHERAPY WITH AUTOLOGOUS STEM CELL SUPPORT IN FIRST LINE TREATMENT OF AGGRESSIVE NON HODGKIN LYMPHOMA: RESULTS OF AN INDIVIDUAL PATIENT DATA META-ANALYSIS / C., Brillant; G., Schwarzer; J., Bohlius; A., Greb; S., Trelle; C., Haioun; A., De Souza; C., Gisselbrecht; T., Intragumtornchai; U., Kaiser; C., Kluin Nelemans; Martelli, Maurizio; N., Milpied; F., Verdonck; U., Vitolo; A., Engert; H., Schulz. - In: HAEMATOLOGICA. - ISSN 0390-6078. - 94:(2009), pp. 392-392. (Intervento presentato al convegno 14th Annual Meeting of the European-Hematology-Association tenutosi a Berlin, GERMANY nel JUN 04-07, 2009).
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/485082
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