Research Papers:

Bayesian network meta-analysis comparing five contemporary treatment strategies for newly diagnosed acute promyelocytic leukaemia

Fenfang Wu, Di Wu, Yong Ren, Chongyang Duan, Shangwu Chen and Anlong Xu _

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Oncotarget. 2016; 7:47319-47331. https://doi.org/10.18632/oncotarget.10118

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Fenfang Wu1,*, Di Wu1,*, Yong Ren1, Chongyang Duan2, Shangwu Chen1, Anlong Xu1,3

1Guangdong Province Key Laboratory for Pharmaceutical Functional Genes, College of Life Sciences, Sun Yat-Sen University, Guangzhou, Guangdong, 510006, People’s Republic of China

2Department of Biostatistics, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China

3Beijing University of Chinese Medicine, Beijing, 100029, People’s Republic of China

*These authors contributed equally to this work

Correspondence to:

Anlong Xu, email: [email protected]

Keywords: acute promyelocytic leukaemia, Bayesian network meta-analysis, arsenic trioxide, all-trans retinoic acid, chemotherapy

Received: March 07, 2016     Accepted: May 20, 2016     Published: June 17, 2016


Acute promyelocytic leukemia (APL) is a curable subtype of acute myeloid leukemia. The optimum regimen for newly diagnosed APL remains inconclusive. In this Bayesian network meta-analysis, we compared the effectiveness of five regimens-arsenic trioxide (ATO) + all-trans retinoic acid (ATRA), realgar-indigo naturalis formula (RIF) which contains arsenic tetrasulfide + ATRA, ATRA + anthracycline-based chemotherapy (CT), ATO alone and ATRA alone, based on fourteen randomized controlled trials (RCTs), which included 1407 newly diagnosed APL patients. According to the results, the ranking efficacy of the treatment, including early death and complete remission in the induction stage, was the following: 1. ATO/RIF + ATRA; 2. ATRA + CT; 3. ATO, and 4. ATRA. For long-term benefit, ATO/RIF + ATRA significantly improved overall survival (OS) (hazard ratio = 0.35, 95%CI 0.15–0.82, p = 0.02) and event-free survival (EFS) (hazard ratio = 0.32, 95%CI 0.16–0.61, p = 0.001) over ATRA + CT regimen for the low-to-intermediate-risk patients. Thus, ATO + ATRA and RIF + ATRA might be considered the optimum treatments for the newly diagnosed APL and should be recommended as the standard care for frontline therapy.

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