TA与DA方案治疗急性髓细胞性白血病的系统评价

目的:系统评价TA方案(吡柔比星+阿糖胞苷)与DA方案(柔红霉素+阿糖胞苷)诱导治疗初治的急性髓系白血病(AML)的有效性和安全性。方法:采用Cochrane系统评价方法,检索《中国期刊全文数据库》、《中国优秀博硕士论文全文数据库》、《中国重要会议论文全文数据库》、《中国图书全文数据库》、《中国引文数据库》、《万方医学期刊》(1994年—2010年)。结果:共纳入3篇随机对照试验348例患者。Meta分析结果显示:TA方案与DA方案诱导治疗初治的急性髓系白血病的完全缓解率、部分缓解率、总有效率的OR及其95%CI分别为1.32(0.84,2.08),0.95(0.51,1.78),1.42(0.83,2.42),差异无统计学意义(P>0.05),TA方案与DA方案在感染发生率方面差异无统计学意义OR=1.10,95%CI(0.60,2.01)],针对骨髓抑制、胃肠道反应、心脏毒性等治疗相关不良反应的发生率分别进行了Meta分析,其各自的结局指标OR及95%CI分别为1.10(0.51～2.36),0.26(0.08～0.88),0.13(0.02～0.76),结果显示TA和DA治疗AML结局指标的差异无统计学意义(P>0.05)。结论:Meta分析结果提示,TA方案治疗初治急性髓系白血病与DA方案疗效相当,在感染发生率、骨髓抑制、胃肠道反应、心脏毒性等治疗相关不良反应的发生率方面,两方案无差异。但上述结果尚需大样本随机对照试验进一步证实。

A systematic review of TA versus DA regimen for patients with acute myelogenous leukemia

Objective:To assess the safety and efficacy of patients with acute myelogenous leukemia(AML)treated with TA scheme(pirarubicin/cytosine arabinoside) and DA scheme(daunorubicin/cytosine arabinoside).Methods:We searched 《China national Knowledge Infrastructure》,《Chinese Selected Doctoral Dissertations and Master′s Theses Full-Text Databases》,《China Proceedings of Conference Full-text Database》,《Chinese Books Full Database》,《Chinese Citation Databases》,《Wangfang Medical Journal》(1994—2010) used by Cochrane Collaboration′s software.Results:Three randomized controlled trials totaling348 patients were included.Meta-analysis results were as follows:There was no significant difference between TA regimen and DA regimen in total complete remission rate95%CI(0.84,2.08)],part remissionrate(0.83,2.42)].There was no significant difference between TA regimen and DA regimen in infection incidence1.10,95%CI(0.60,2.01)],heart toxicity incidence95%CI(0.08~0.88)].Conclusion:TA regimen is not superior to TA regimen in treating newly diagnosed acute myelogenous leukemia patients regarding total complete remission rate,part remissionrate,and effective rate.Inductive treatment with TA regimen for acute myelogenous leukemia has similar infection incidence,heart toxicity incidence,nausea and vomiting compared with DA regimen.They still need to be confirmed by large sample,high quality randomized controlled trials.