TKIs联合自体造血干细胞移植治疗成人费成染色体阳性急性淋巴细胞白血病的Meta分析

目的探讨酪氨酸激酶抑制剂(TKIs)联合自体造血干细胞移植治疗成人费城染色体阳性急性淋巴细胞白血病(Ph+ALL)的效果。方法通过计算机检索PubMed、Embase、Cochrane library、CNKI、万方、维普等数据库,检索时间均从建库至2019年6月30日,检索TKIs联合自体与异基因造血干细胞移植治疗成人Ph+ALL的临床对照试验。由2位研究者严格按照纳入标准与排除标准独立筛选相关文献、提取资料和评价纳入研究的方法学质量,采用RevMan 5.3软件进行Meta分析。结果全面检索得到892篇相关文献。最终纳入5篇文献,总共872例患者,其中自体造血干细胞移植(auto-HSCT)组136例,异基因造血干细胞移植(allo-HSCT)组736例。Meta分析结果显示,自体组与异基因组相比,二者总体生存率(OR=1.14,95%CI:0.77~1.70,P=0.52)、无病生存率(OR=1.35,95%CI:0.56~3.28,P=0.50)、非复发死亡率(OR=0.42,95%CI:0.00~60.76,P=0.73),差异均无统计学意义。结论对于不能耐受异基因造血干细胞移植的Ph+ALL患者,TKIs联合自体移植可能使患者获益。

TKIs combined with autologous hematopoietic stem cell transplantation for adult Ph+acute lymphoblastic leukemia:a Meta analysis

Objective To investigate the effect of tyrosine kinase inhibitors(TKIs)combined with autologous transplantation in the treatment of adult Philadelphia chromosome-positive acute lymphoblastic leukemia(Ph+ALL)in the era of TKIs.Methods The databases of PubMed,Embase,Cochrane Library,CNKI,Wanfang Data and VIP were retrieved by computer from the database establishment to June 30,2019.All the ALL clinical controlled trials of TKIs combined autologous and allogeneic hematopoietic stem cell transplantation in the treatment of Ph+ALL in adults were retrieved.Two researchers independently screened the related literatures according to the inclusion and exclusion standards,and extracted the data and evaluated the methodologic quality of included studies.The RevMan5.3 software was used for conducting the Meta analysis.Results Totally 892 related literatures were searched.Finally,5 literatures included 872 patients were enrolled,of which 136 were in the auto-HSCT group and 736 were in the allo-HSCT group.Meta analysis showed that there was no significant difference in overall survival rate(OR=1.14,95%CI:0.77-1.70,P=0.52),disease-free survival rate(OR=1.35,95%CI:0.56-3.28,P=0.50)or nonrelapsed mortality rate(OR=0.42,95%CI:0.00-60.76,P=0.73).Conclusion TKIs combined with autologous transplantation can benefit the patients who cannot tolerate allogeneic hematopoietic stem cell transplantation.