Objective To evaluate the effectiveness and safety of chemotherapy regimens represented by pirarubicin (THP) vs. adriamycin hydrochloride (ADM) for non-Hodgkin lymphoma (NHL) in mainland China. Methods The randomized controlled trials (RCTs) about THP vs. ADM for treating NHL were collected in the databases such as CNKI, CBM, VIP and WanFang Data, and the references of the included studies were also retrieved manually, with the retrieval time from January 1989 to September 2012. According to the inclusion and exclusion criteria, two reviewers independently screened articles, extracted data, and assessed the methodological quality of the included studies. Then meta-analysis was performed using RevMan 5.0 software. Results A total of 15 RCTs involving 1 659 patients were included. The results of meta-analysis showed that: a) As for the total effective rate, the CTOP (C: cyclophosphamide, T: pirarubicin, O: vincristine, P: prednison) regimen was superior to the CHOP (C: cyclophosphamide H: adriamycin hydrochloride, O: vincristine, P: prednison) regimen with a significant difference (OR=1.07, 95%CI 1.02 to 1.12, P=0.006); and b) As for the safety, there were significant differences between the two groups in the incidence of cardiac toxicity (OR=0.42, 95%CI 0.30 to 0.57, Plt;0.000 01), gastrointestinal tract response (OR=0.69, 95%CI 0.56 to 0.85, P=0.000 5) and liver damage (OR=0.69, 95%CI 0.48 to 1.00, P=0.05). But no significant differences were found between the two groups in the incidence of mye1osuppression: the decreased hemoglobin (OR=0.83, 95%CI 0.61 to 1.14, P=0.25), leucopenia (OR=0.85, 95%CI 0.68 to 1.07, P=0.17), and thrombocytopenia (OR=0.99, 95%CI 0.70 to 1.39, P=0.95). Conclusion Based on the domestic evidences at current and compared with CHOP regimen represented by ADM, CTOP regimen represented by THP for treating NHL shows a higher total effective rate and less side effects. However, more high quality, large sample and double blind RCTs are required to prove this conclusion for the quality and quantity limitation of the included studies.
【摘要】 目的 探討米卡芬凈在有侵襲性真菌感染（invasive fungal infection，IFI）病史的患者行造血干細胞移植（haematopoietic stem cell transplantation，HSCT）時二級預防（secondary anti-fungal prophylaxis，SAP）的有效性和安全性。 方法 選擇2009年1月-2011年1月行HSCT治療血液病患者中有IFI史的18例患者，從預處理進行SAP，13例開始即使用米卡芬凈鈉，5例開始選用伏立康唑，后換為米卡芬凈。預防至危險期結束（白細胞植活、無感染癥狀），18例患者隨訪時間62～220 d，中位隨訪時間為124 d。 結果 米卡芬凈治療有效17例，1例在預防期間+27 d出現真菌突破感染。預防過程中1例在輸注的第2天出現軀干充血性皮疹伴瘙癢，經抗過敏治療后逐漸好轉。17例患者在米卡芬凈使用過程中未觀察嚴重不良反應發生，也未因此而調整環胞素A治療濃度。 結論 米卡芬凈作為HSCT中SAP的備選用藥之一是安全、有效的。【Abstract】 Objective To investigate the efficacy of micafungin on secondary anti-fungal prophylaxis (SAP) in hematopoietie stem cell transplantation (HSCT) recipients who had a history of antecedent invasive fungal infection (IFI) and to observe the safety of micafungin. Methods The patients with hematological diseases，who underwent HSCT between January 2009 and January 2011, received our routine conditioning regimen. The patients, who had a history of antecedent IFI, were given by micafungin for SAP from the start of conditioning chemotherapy until the end of the risk period. Results There were 18 patients had a history of antecedent IFI. The overall efficacy of micafungin was 17/18. One patients had IFI on the +27th day during SAP; one patient had body congestive rash accompanied with pruritus in the prevention period 2 days after treatment, who got better gradually after antianaphylaxis treatment. No patients had server adverse reaction and the concentration of cyclosporine A was not changed. Conclusion Micafungin as one of drugs for SAP Is effective and safe for HSCT.
