Effect of initial treatment strategy on survival of patients with advanced-stage Hodgkin's lymphoma: a systematic review and network meta-analysis

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• 作者：Nicole Skoetz ; Sven Trelle ; Michaela Rancea ; Heinz Haverkamp ; Volker Diehl ; Andreas Engert ; Peter Borchmann
• 刊名：Lancet Oncology
• 出版年：2013
• 出版时间：September, 2013
• 年：2013
• 卷：14
• 期：10
• 页码：943-952
• 全文大小：410 K

文摘

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Summary

Background

Several treatment strategies are available for adults with advanced-stage Hodgkin's lymphoma, but studies assessing two alternative standards of care¡ªincreased dose bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP_escalated), and doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD)¡ªwere not powered to test differences in overall survival. To guide treatment decisions in this population of patients, we did a systematic review and network meta-analysis to identify the best initial treatment strategy.

Methods

We searched the Cochrane Library, Medline, and conference proceedings for randomised controlled trials published between January, 1980, and June, 2013, that assessed overall survival in patients with advanced-stage Hodgkin's lymphoma given BEACOPP_baseline, BEACOPP_escalated, BEACOPP variants, ABVD, cyclophosphamide (mechlorethamine), vincristine, procarbazine, and prednisone (C[M]OPP), hybrid or alternating chemotherapy regimens with ABVD as the backbone (eg, COPP/ABVD, MOPP/ABVD), or doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, and prednisone combined with radiation therapy (the Stanford V regimen). We assessed studies for eligibility, extracted data, and assessed their quality. We then pooled the data and used a Bayesian random-effects model to combine direct comparisons with indirect evidence. We also reconstructed individual patient survival data from published Kaplan-Meier curves and did standard random-effects Poisson regression. Results are reported relative to ABVD. The primary outcome was overall survival.

Findings

We screened 2055 records and identified 75 papers covering 14 eligible trials that assessed 11 different regimens in 9993 patients, providing 59?651 patient-years of follow-up. 1189 patients died, and the median follow-up was 5¡¤9 years (IQR 4¡¤9-6¡¤7). Included studies were of high methodological quality, and between-trial heterogeneity was negligible (¦Ó²=0¡¤01). Overall survival was highest in patients who received six cycles of BEACOPP_escalated (HR 0¡¤38, 95 % credibility interval [CrI] 0¡¤20-0¡¤75). Compared with a 5 year survival of 88 % for ABVD, the survival benefit for six cycles of BEACOPP_escalated is 7 % (95 % CrI 3-10)¡ªie, a 5 year survival of 95 % . Reconstructed individual survival data showed that, at 5 years, BEACOPP_escalated has a 10 % (95 % CI 3-15) advantage over ABVD in overall survival.

Interpretation

Six cycles of BEACOPP_escalated significantly improves overall survival compared with ABVD and other regimens, and thus we recommend this treatment strategy as standard of care for patients with access to the appropriate supportive care.

Funding

None.