嘌呤类似物单用或联合环磷酰胺治疗慢性淋巴细胞白血病安全性的Meta分析

目的系统评价嘌呤类似物联合环磷酰胺与单用嘌呤类似物治疗慢性淋巴细胞白血病（CLL）的安全性。方法检索PubMed数据库、ISI数据库、Embase数据库、Cochrane图书馆临床对照试验数据库、OVID数据库嘌呤类似物联合环磷酰胺、单用嘌呤类似物治疗CLL的随机对照试验，按Cochrance协作网推荐的方法进行质量评价、资料提取，采用Revman4．3．2软件进行Meta分析。结果共纳入4个随机对照试验，包括1358例患者。Meta分析结果显示，嘌呤类似物联合环磷酰胺与单用嘌呤类似物比较，严重白细胞减少（Ⅲ-Ⅳ级）发生率增加，差异有统计学意义RR=1．47，95％置信区间（CI）1．10—1．98，P=0．011；严重贫血（Ⅲ—Ⅳ级）（RR=1．03，95％C10．74—1．43，P=0．87）、血小板减少（Ⅲ～Ⅳ级）（RR=1．28，95％CIO．99～1．65，P=0．06）发生率差异无统计学意义。结论与单用嘌呤类似物治疗CLL比较，嘌呤类似物联合环磷酰胺严重贫血、血小板减少发生率无明显增加，但严重白细胞减少发生率增加，临床使用时应引起重视。

Meta-analysis on safety of purine analogues alone or combined with cyclophosphamide in the treatment of chronic lymphocytic leukemia

Objective To assess the safety of purine nucleoside analogues （PNA） plus cyclophosphamide （CTX） and single PNA in the treatment of chronic lymphocytic leukemia （CLL）. Methods The databases such as PubMed, ISI, Embase, The Cochrane Library, and OVID were searched. Randomized controlled trials （RCT） that compared PNA plus CTX with single PNAs in the treatment of CLL were included. The quality of included trials was evaluated. Date were extracted by two reviewers independently. Revman 4.3.2 software was used for data analysis. Results Four RCT studies and 1 358 cases were brought in. Incidence of Ⅲ/Ⅳ neutropenia （RR 1.47, 95 % CI 1.10-1.98, P = 0.01） was significantly higher in patients receiving PNA plus CTX than single PNA, but no significant differences were detectable concerning the incidence of Ⅲ/Ⅳ anemia （RR 1.03, 95 % CI 0.74-1.43, P = 0.87） and Ⅲ/Ⅳ thrombocytopenia （RR 1.28, 95 % CI 0.99-1.65, P = 0.06）. Conclusions The incidence of severe anemia or thrombocytopenia is not significantly increased in patients with CLL receiving PNA plus CTX than single PNA, but the incidence of severe neutropenia is significantly increased, to which more attention should be paid when using PNA plus CTX clinically.