Gurion Ronit, Gafter-Gvili Anat, Paul Mical, Vidal Liat, Ben-Bassat Isaac, Yeshurun Moshe, Shpilberg Ofer, Raanani Pia
Institute of Hematology, Davidoff Center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.
Haematologica. 2009 May;94(5):712-9. doi: 10.3324/haematol.2008.002170. Epub 2009 Mar 31.
Immunosuppressive therapy is the treatment for aplastic anemia patients ineligible for transplantation. The role of hematopoietic growth factors as adjunct to treatment in these patients is unclear. We conducted a systematic review and meta-analysis of randomized controlled trials comparing treatment with immunosuppressive therapy and hematopoietic growth factors to immunosuppressive therapy alone in patients with aplastic anemia. Two reviewers appraised the quality of trials and extracted data. For each trial, results were expressed as relative risks with 95% confidence intervals (CI) for dichotomous data. The addition of hematopoietic growth factors yielded no difference in overall mortality at 100 days, one year and five years [relative risks 1.33 (95% CI 0.56-3.18), relative risks 0.90 (95% CI 0.50-1.63) and relative risks 0.89 (95% CI 0.55-1.46), respectively]. There was no difference in overall hematologic response and in the occurrence of infections. HGF significantly decreased the risk for relapse, relative risks 0.45 (95% CI 0.30-0.68, 3 trials). Hematopoietic growth factors were not associated with higher occurrence of myelodysplastic syndrome and acute myeloid leukemia or paroxysmal nocturnal hemoglobinuria. The addition of hematopoietic growth factors does not affect mortality, response rate or infections occurrence. Therefore, it should not be recommended routinely as an adjunct to the immunosuppressive therapy for patients with aplastic anemia.
免疫抑制疗法是不适于移植的再生障碍性贫血患者的治疗方法。造血生长因子作为这些患者治疗辅助手段的作用尚不清楚。我们对随机对照试验进行了系统评价和荟萃分析，比较再生障碍性贫血患者接受免疫抑制疗法联合造血生长因子治疗与单纯免疫抑制疗法的效果。两名评价者评估试验质量并提取数据。对于每项试验，结果以二分类数据的相对风险及95%置信区间（CI）表示。添加造血生长因子在100天、1年和5年的总死亡率方面无差异[相对风险分别为1.33（95%CI 0.56 - 3.18）、相对风险0.90（95%CI 0.50 - 1.63）和相对风险0.89（95%CI 0.55 - 1.46）]。在总体血液学反应和感染发生率方面无差异。造血生长因子显著降低了复发风险，相对风险0.45（95%CI 0.30 - 0.68，3项试验）。造血生长因子与骨髓增生异常综合征、急性髓系白血病或阵发性睡眠性血红蛋白尿的较高发生率无关。添加造血生长因子不影响死亡率、缓解率或感染发生率。因此，不应常规推荐将其作为再生障碍性贫血患者免疫抑制疗法的辅助手段。
