Pan Tingting, Qi Jiaqian, You Tao, Yang Liping, Wu Depei, Han Yue, Zhu Li
Cyrus Tang Hematology Center, Soochow University, Suzhou, China; The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Suzhou, China; Collaborative Innovation Center of Hematology, Suzhou, China; Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China.
The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Suzhou, China.
Leuk Res. 2018 Aug;71:13-24. doi: 10.1016/j.leukres.2018.06.007. Epub 2018 Jun 9.
To compare the efficacy and safety between hypomethylating agent (HMA) alone and the combination of HMA and histone deacetylase inhibitor (HDACi) in myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML).
We performed a systematic review and meta-analysis of all available cohort studies regarding the comparison of HMA alone and in combination with HDACi for MDS and AML. Embase and Pubmed databases were searched for relevant studies. The overall hazard ratios for the HMA alone and HDACi combination were extracted. Heterogeneity among the included studies was evaluated by Cochrane's Q Test and I statistics. A random-effect model or a fixed-effect model was applied depending on the heterogeneity. Subgroup analysis was used to evaluate the source of heterogeneity.
Seven studies comprising 922 patients (458 patients treated with HMA alone and 464 with HMA and HDACi) were included in the analysis. Pooled data showed no significant differences in complete remission (CR) rates, hematologic improvement (HI), overall response rate (ORR), overall survival (OS), and toxicities between HMA alone treatment and HMA with HDACi regimens.
HDACi and HMA combination does not appear to be more effective and better tolerated than HMA alone. Future randomized controlled trials are needed to confirm its efficacy and safety.
比较单独使用低甲基化药物（HMA）与HMA联合组蛋白去乙酰化酶抑制剂（HDACi）治疗骨髓增生异常综合征（MDS）或急性髓系白血病（AML）的疗效和安全性。
我们对所有关于单独使用HMA以及HMA联合HDACi治疗MDS和AML的队列研究进行了系统评价和荟萃分析。在Embase和Pubmed数据库中检索相关研究。提取单独使用HMA和HDACi联合治疗的总体风险比。采用Cochrane's Q检验和I统计量评估纳入研究之间的异质性。根据异质性情况应用随机效应模型或固定效应模型。采用亚组分析评估异质性来源。
分析纳入了7项研究，共922例患者（458例单独接受HMA治疗，464例接受HMA联合HDACi治疗）。汇总数据显示，单独使用HMA治疗与HMA联合HDACi治疗方案在完全缓解（CR）率、血液学改善（HI）、总缓解率（ORR）、总生存期（OS）和毒性方面无显著差异。
HDACi与HMA联合使用似乎并不比单独使用HMA更有效，耐受性也更好。未来需要进行随机对照试验来证实其疗效和安全性。
