Gupta Aditya Kumar, Meena Jagdish Prasad, Haldar Partha, Tanwar Pranay, Seth Rachna
Division of Pediatric Oncology, Department of Pediatrics, All India Institute of Medical Sciences New Delhi 110029, India.
Department of Community Medicine, All India Institute of Medical Sciences New Delhi 110029, India.
Am J Blood Res. 2021 Oct 15;11(5):544-563. eCollection 2021.
Granulocyte colony-stimulating factors (G-CSFs) have been used post hematopoietic stem cell transplant (HSCT) for earlier neutrophil engraftment. The use of G-CSFs, and their effect on other post-HSCT outcomes remains debatable. In this systematic review and meta-analysis, we searched PubMed, Embase, Cochrane library, Google Scholar, and IndMed using a predefined search strategy. We included randomized controlled trials (RCTs) and non-randomized studies (NRSs) reporting data on G-CSF administration post-HSCT, published in the English language from their inception until Jan 31, 2021. The primary outcome of this systematic review and meta-analysis was to evaluate the time to neutrophil engraftment (NE). The secondary outcomes were probability of NE, time to platelet engraftment (PE), the incidence of graft-versus-host disease (GVHD), duration of hospital stay (HS), and overall survival (OS). The review is registered with PROSPERO (CRD42020206989). Fourteen studies were extracted (n=9850), of which five were RCTs, and nine were NRSs. As per Egger's test, publication bias was not present for any outcome. After meta-analysis, we found that the duration of NE favouring G-CSF arm from RCTs was -0.94 days (SMD) [(95% CI: -1.38, -0.51); I=35%], and from NRSs -1.2 days (SMD) [(95% CI: -1.43, -0.96); I=74%]. For the outcome of GVHD, the relative risks (RR) of incidence for chronic GVHD and overall GVHD were not significant for the RCTs, and these were 1.11 (RR) [(95% CI: 1.00, 1.22); I=43%] and 1.10 (RR) [(95% CI: 1.03, 1.18); I=48%], respectively for NRSs. There was no difference in the incidence of GVHD (acute or chronic) in both arms. No significant difference was found between the two arms for the outcomes of PE, HS, and OS. For NE, there was a marginal benefit of around one day with the use of G-CSF. The use of G-CSF did not alter time to PE, the incidence of GVHD, HS, and OS in both arms.
粒细胞集落刺激因子（G-CSFs）已用于造血干细胞移植（HSCT）后，以促进中性粒细胞更早植入。G-CSFs的使用及其对HSCT后其他结局的影响仍存在争议。在这项系统评价和荟萃分析中，我们使用预定义的检索策略检索了PubMed、Embase、Cochrane图书馆、谷歌学术和印度医学数据库。我们纳入了自开始至2021年1月31日以英文发表的报告HSCT后G-CSF给药数据的随机对照试验（RCTs）和非随机研究（NRSs）。这项系统评价和荟萃分析的主要结局是评估中性粒细胞植入时间（NE）。次要结局包括中性粒细胞植入概率、血小板植入时间（PE）、移植物抗宿主病（GVHD）发生率、住院时间（HS）和总生存期（OS）。该评价已在国际前瞻性系统评价注册库（PROSPERO）注册（注册号：CRD42020206989）。提取了14项研究（n = 9850），其中5项为RCTs，9项为NRSs。根据Egger检验，各结局均不存在发表偏倚。荟萃分析后，我们发现RCTs中G-CSF组中性粒细胞植入持续时间的标准化均数差（SMD）为-0.94天[（95%CI：-1.38，-0.51）；I² = 35%]，NRSs中为-1.2天[（95%CI：-1.43，-0.96）；I² = 74%]。对于GVHD结局，RCTs中慢性GVHD和总体GVHD的发病相对危险度（RR）无统计学意义，NRSs中分别为1.11（RR）[（95%CI：1.00，1.22）；I² = 43%]和1.10（RR）[（95%CI：1.03，1.18）；I² = 48%]。两组GVHD（急性或慢性）发生率无差异。PE、HS和OS结局在两组之间未发现显著差异。对于NE，使用G-CSF有大约1天的边际益处。使用G-CSF未改变两组的PE时间、GVHD发生率、HS和OS。
