采用类CHOP方案治疗非霍奇金淋巴瘤时间质性肺炎的危险因素及发病率的Meta分析
Meta-Analysis of Risk Factors and Incidence of Interstitial Pneumonia With CHOP-Like Regimens for Non-Hodgkin Lymphoma.
作者信息
Yang Jing, Chai Limin, Jia Junting, Su Liping, Hao Zhiying
机构信息
Department of Pharmacy, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Shanxi, China.
Department of Haematology-Oncology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Shanxi, China.
出版信息
Front Oncol. 2022 Jun 1;12:880144. doi: 10.3389/fonc.2022.880144. eCollection 2022.
OBJECTIVES
Interstitial pneumonitis (IP), a potentially fatal complication of non-Hodgkin Lymphoma (NHL) patients received CHOP (cyclophosphamide and doxorubicin and vincristine and prednisone)-like chemotherapy, negatively affected patients' clinical outcome and quality of life. We aimed to explore patient-related, disease-related and drug-related risk factors associated with IP and gain a better understanding of the incidence in NHL patients.
METHODS
Databases, including PubMed, Ovid, China National Knowledge Internet (CNKI), and Wanfang Database from inception to January 20, 2022, were searched to identify studies evaluating the risk factors and incidence of IP. The included studies were assessed by Newcastle-Ottawa Quality Scale and above 7 points was considered high quality. The statistical analysis of risk factors was assessed by RevMan software (version 5.3) and incidence of IP was calculated by R software (version 4.1.2). Fixed-or random-effects models were applied to estimated the relative risks (RRs) and 95% confidence interval (Cl).
RESULTS
A total of 12 studies comprised of 3423 NHL patients were included in the analysis. Among the 3 available patient-related risk factors, 6 disease-related risk factors and 3 drug-related risk factors, it was found that only drug-related risk factors were significantly associated with IP development: pegylated liposomes doxorubicin (PLD) replacement (RR = 3.25, 95% CI = 1.69-6.27, 64%), rituximab (RTX) addition (RR = 4.24, 95% CI = 2.58-6.96, 0) and granulocyte colony stimulating factor (G-CSF) administration (RR = 5.80, 95% CI = 3.05-11.05, 0). The pooled incidence of CHOP, R-CHOP, and R-CDOP regimen was 1.0% (95% CI 0.00-0.01, = 8%), 7.0% (95% CI 0.05-0.09, = 64%) and 22.0% (95% CI 0.13-0.32, = 87%) respectively.
CONCLUSION
PLD replacement, RTX addition and G-CSF administration were significant risk factors of IP for NHL patients received the CHOP-like chemotherapy. Clinicians should focus on these patients to detect and treat the IP development timely, which might bring benefit in patients' survival.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, identifier CRD42022309884.
目的
间质性肺炎（IP）是非霍奇金淋巴瘤（NHL）患者接受CHOP（环磷酰胺、阿霉素、长春新碱和泼尼松）类化疗的一种潜在致命并发症，对患者的临床结局和生活质量产生负面影响。我们旨在探讨与IP相关的患者相关、疾病相关和药物相关风险因素，并更好地了解NHL患者的发病率。
方法
检索包括PubMed、Ovid、中国知网（CNKI）和万方数据库在内的数据库，检索时间从建库至2022年1月20日，以识别评估IP风险因素和发病率的研究。纳入的研究采用纽卡斯尔-渥太华质量量表进行评估，7分及以上被认为是高质量。通过RevMan软件（5.3版）评估风险因素的统计分析，并通过R软件（4.1.2版）计算IP的发病率。应用固定效应或随机效应模型估计相对风险（RRs）和95%置信区间（Cl）。
结果
分析共纳入12项研究，包括3423例NHL患者。在3个可用的患者相关风险因素、6个疾病相关风险因素和3个药物相关风险因素中，发现只有药物相关风险因素与IP发生显著相关：聚乙二醇脂质体阿霉素（PLD）替代（RR = 3.25，95% CI = 1.69 - 6.27，64%）、添加利妥昔单抗（RTX）（RR = 4.24，95% CI = 2.58 - 6.96，0）和使用粒细胞集落刺激因子（G-CSF）（RR = 5.80，95% CI = 3.05 - 11.05，0）。CHOP、R-CHOP和R-CDOP方案的合并发病率分别为1.0%（95% CI 0.00 - 0.01，= 8%）、7.0%（95% CI 0.05 - 0.09，= 64%）和22.0%（95% CI 0.13 - 0.32，= 87%）。
结论
PLD替代、添加RTX和使用G-CSF是接受CHOP类化疗的NHL患者发生IP的显著风险因素。临床医生应关注这些患者，及时发现和治疗IP的发生，这可能对患者的生存有益。
系统评价注册
PROSPERO，标识符CRD42022309884。
Zotero 插件