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目的系统评价大剂量化疗后自体干细胞移植一线治疗滤泡性淋巴瘤的临床疗效与安全性。方法计算机检索MEDLIN(E1990～2009)、EMbase(1990～2009)、OVID(1990～2009)和Cochrane图书馆(2009年第2期),手工检索美国血液年会(ASH)会议记录及相关文献的参考文献,评价纳入研究的方法学质量,采用STATA10.0软件和RevMan4.3软件进行统计分析。结果共纳入4个随机对照试验,包括941例患者。Meta分析结果显示:大剂量化疗后自体干细胞移植一线治疗滤泡性淋巴瘤与常规化疗相比,总生存率[RR=1.02,95%CI(0.94,1.11),P=0.59]、总缓解率[RR=0.96,95%CI(0.71,1.30),P=0.78]、继发恶性肿瘤发生率方面,两组差异无统计学意义,但在无事件生存率方面[RR=1.61,95%CI(1.25,2.07),P=0.000-2],大剂量化疗后自体干细胞移植治疗优于常规治疗。结论现有证据表明,大剂量化疗后自体干细胞移植一线治疗滤泡性淋巴瘤与常规化疗相比,不能改善患者的总生存率及总缓解率,但能提高无事件生存率,不增加继发恶性肿瘤发生的风险。本研究纳入病例数较少,结论尚需高质量多中心大样本随机对照试验证实。
Objective To evaluate the clinical efficacy and safety of autologous stem cell transplantation for the treatment of follicular lymphoma after high-dose chemotherapy. Methods MEDLINE (E1990 ~ 2009), EMbase (1990 ~ 2009), OVID (1990 ~ 2009) and the Cochrane Library (No.2 2009) were searched by computer. The records of ASH meetings and related documents References, evaluating the quality of methodological studies included in the study, using STATA 10.0 software and RevMan 4.3 software for statistical analysis. Results A total of 4 randomized controlled trials were included, including 941 patients. The results of Meta analysis showed that the overall survival rate of the first-line treatment of follicular lymphoma after high-dose chemotherapy with autologous stem cell transplantation was significantly lower than that of the conventional chemotherapy (RR = 1.02, 95% CI 0.94,1.11, P = 0.59) [RR = 0.96,95% CI (0.71,1.30), P = 0.78] There was no significant difference between the two groups in the incidence of secondary malignancies, but in the event-free survival rate [RR = 1.61,95% CI (1.25,2.07), P = 0.000-2], high-dose chemotherapy after autologous stem cell transplantation is superior to conventional treatment. Conclusion The available evidence shows that the first-line treatment of follicular lymphoma with high-dose chemotherapy can not improve the overall survival and overall response rate of patients with follicular lymphoma, but can improve the event-free survival rate without increasing secondary Risk of malignancy. The number of cases enrolled in this study is small, and the conclusion remains to be confirmed by randomized controlled trials of large, multicenter, high-quality samples.