Watson Crystal, Barlev Arie, Worrall Jodie, Duff Steve, Beckerman Rachel
Atara Biotherapeutics, Inc, South San Francisco, CA, USA.
Maple Health Group, New York, NY, USA.
J Drug Assess. 2020 Dec 24;10(1):18-26. doi: 10.1080/21556660.2020.1854561.
Cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) is a treatment for post-transplant lymphoproliferative disease (PTLD) following solid organ transplant (SOT) after failing rituximab, an aggressive and potentially fatal lymphoma. This study explores the humanistic and economic burden of CHOP-associated adverse events (AEs) in PTLD patients. Since PTLD is rare, searches included lymphoproliferative disease with lymphoma patients.
This comprehensive literature review used the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) protocol, pre-specifying the search strategy and criteria. CHOP-associated short-term AEs with an incidence of >4% were sourced from published literature and cancer websites to inform the search strategy. PubMed and EMBASE searches were used to identify humanistic and economic burden studies.
PubMed and EMBASE searches identified 3946 citations with 27 lymphoma studies included. Studies were methodologically heterogeneous. Febrile neutropenia (FN) was the AE most encountered, followed by chemotherapy-induced (CI) anemia (A), infection, CI-nausea and vomiting, thrombocytopenia, and CI-peripheral neuropathy (PN). FN and infections were associated with significant disutility, increased hospitalization, and extended length of stay (LOS). Infections and CIPN significantly impacted the utility of patients and CIA-related fatigue showed reductions in quality of life (QoL). Many patients continue to have QoL deficits continued even after AEs were treated. Management costs varied greatly, ranging from nominal (CIPN) to over $100,000 in the USA for infections, EUR 10,290 in Europe for infections, or CAN$1012 in Canada for FN. Cost of outpatient care varied but had a lower economic impact compared to hospitalizations.
Short-term AEs from CHOP in the lymphoma population were associated with substantial humanistic and economic burden.
环磷酰胺、多柔比星、长春新碱、泼尼松（CHOP）方案是用于实体器官移植（SOT）后发生移植后淋巴细胞增生性疾病（PTLD）且利妥昔单抗治疗失败的一种疗法，PTLD是一种侵袭性且可能致命的淋巴瘤。本研究探讨CHOP相关不良事件（AE）对PTLD患者造成的人文和经济负担。由于PTLD较为罕见，检索范围包括淋巴瘤患者的淋巴细胞增生性疾病。
本全面的文献综述采用系统评价与Meta分析的首选报告项目（PRISMA）方案，预先确定检索策略和标准。从已发表文献和癌症网站获取CHOP相关短期不良事件发生率>4%的数据，以指导检索策略。通过检索PubMed和EMBASE来识别关于人文和经济负担的研究。
PubMed和EMBASE检索共识别出3946条引文，纳入了27项淋巴瘤研究。这些研究在方法上存在异质性。发热性中性粒细胞减少症（FN）是最常遇到的不良事件，其次是化疗引起的（CI）贫血（A）、感染、CI引起的恶心和呕吐、血小板减少症以及CI引起的周围神经病变（PN）。FN和感染与显著的负效用、住院次数增加以及住院时间延长相关。感染和CIPN对患者的效用有显著影响，且CI贫血相关的疲劳导致生活质量（QoL）下降。即使不良事件得到治疗，许多患者的生活质量仍持续存在缺陷。管理成本差异很大，从名义成本（CIPN）到美国因感染超过10万美元、欧洲因感染10290欧元或加拿大因FN 1012加元不等。门诊护理成本各不相同，但与住院相比，其经济影响较小。
淋巴瘤患者接受CHOP方案治疗产生的短期不良事件与巨大的人文和经济负担相关。
