Induction treatments for acute promyelocytic leukemia: a network meta-analysis
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Junjie Huang1,*, Min Sun2,*, Zitong Wang3,*, Qiaoxia Zhang1, Jin Lou1, Yun Cai1, Weihong Chen1, Xin Du1
1Shenzhen Bone Marrow Transplantation Public Service Platform, Department of Hematology, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen 518000, China
2Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
3The University of Sydney Medical School, Sydney, NSW 2006, Australia
*These authors have contributed equally to this work
Xin Du, email: [email protected]
Keywords: induction treatment, acute promyelocytic leukemia, network meta-analysis
Received: May 03, 2016 Accepted: September 28, 2016 Published: October 04, 2016
Background: 9 treatments for acute promyelocytic leukemia (APL) have been compared in many randomized controlled trials (RCT). The conclusions have been inconsistent and the purpose of this study is to conduct a network meta-analysis.
Results: Rankings of event-free survival are ATRA+RIF (81.2%), ATRA+ATO (69.6%), ATO (50.6%). Rankings of complete remission are ATRA+RIF (79.3%), ATRA+ATO (64.8%), RIF (60.3%), ATO (55.9%). Rankings of avoiding differentiation syndromes are CT (84.3%), ATO (80.3%), RIF (71.6%), ATRA+RIF (49%), ATRA+ATO (40.8%).
Methods: A total of 1,666 patients from 12 RCTs were enrolled. The frequentist method was used. Relative risks with 95% confidence intervals were calculated. We produced a network plot, a contribution plot, and a forest plot predictive intervals. The inconsistency factor, the surface under the cumulative ranking curve and the publication bias were evaluated.
Conclusions: ATRA+ATO is eligible to be the first-line treatment for APL. ATRA+RIF is a prospective alternative to the first-line treatment. RIF or ATO should be reconsidered as another option for de novo APL.
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