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酪氨酸激酶抑制剂(TKIs)单药治疗及联合其他治疗对慢性髓性白血病患者健康相关生活质量的影响:随机对照试验的系统评价

The Effects of Tyrosine Kinase Inhibitors (TKIs) in Monotherapy and with Add-on Treatments on Health-related Quality of Life of People with Chronic Myeloid Leukemia: A Systematic Review of Randomized-Controlled Trials.

作者信息

Nardi Antonio E, Sancassiani Federica, Barrui Vanessa, Kalcev Goce, Uras Veronica, Meloni Giulia, Marongiu Luigi, Tamburini Giorgio, Maleci Alberto, Quagliato Laiana A, La Nasa Giorgio, Carta Mauro Giovanni

机构信息

Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.

Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.

出版信息

Clin Pract Epidemiol Ment Health. 2023 Jan 5;19(Suppl-1):e1745017921112200. doi: 10.2174/17450179-v17-e211118-2021-HT2-1910-12. eCollection 2023.

Abstract

BACKGROUND

The era of establishing tyrosine kinase inhibitors (TKIs) in the treatment of chronic myeloid leukemia (CML) changed the outcome and the course of this life-threatening malignancy. People suffering from CML have now a better prognosis and a longer life expectancy due to the development of TKIs, even if it requires long-term, often lifelong, treatments that are nonetheless associated with improved Health-related Quality of life (HRQoL). However, data on the effects of TKIs on HRQoL are not always systematic; sometimes the data have been obtained by studies different from RCTs, or without a clear definition of what HRQoL is. The main purpose of this systematic review is to summarize all randomized-controlled trials (RCTs) including HRQoL as main or secondary outcome in patients with CML treated with TKIs or with TKIs plus an add-on treatment.

METHODS

A systematic review has been conducted by searching the relevant papers in PubMed/Medline and Web of Science with the following keywords: "quality of life" OR "health-related quality of life" OR "QoL" OR "HRQoL" OR "H-QoL" AND "chronic myeloid leukemia". Interval was set from January 2000 to December 2020.

RESULTS

40 papers were identified through the search. Out of them, 7 RCTs were included. All the studies used standardized measures to assess HRQoL, even not always specific for CML. 5 RCTs randomized subjects to 2 or 3 arms to evaluate the effects of TKIs of the first, second and third generation in monotherapy. 2 RCTs randomized subjects to TKI therapy plus an add-on treatment TKI therapy as usual. The results of all these trials were examined and discussed.

CONCLUSION

All the included RCTs pointed out significant findings regarding the positive effects of TKIs on HRQoL of people with CML, both when they were used in monotherapy or, notably, with an add-on treatment to enhance TKIs effects.

摘要

背景

酪氨酸激酶抑制剂(TKIs)应用于慢性髓性白血病(CML)治疗的时代改变了这种危及生命的恶性肿瘤的治疗结果和病程。由于TKIs的发展,CML患者现在有了更好的预后和更长的预期寿命,即使这需要长期(通常是终身)治疗,而这些治疗仍与健康相关生活质量(HRQoL)的改善相关。然而,关于TKIs对HRQoL影响的数据并不总是系统的;有时数据是通过与随机对照试验(RCTs)不同的研究获得的,或者没有对HRQoL进行明确的定义。本系统评价的主要目的是总结所有将HRQoL作为主要或次要结局的随机对照试验(RCTs),这些试验涉及接受TKIs治疗或TKIs加附加治疗的CML患者。

方法

通过在PubMed/Medline和Web of Science中搜索相关论文进行系统评价,关键词如下:“生活质量”或“健康相关生活质量”或“QoL”或“HRQoL”或“H-QoL”以及“慢性髓性白血病”。时间范围设定为2000年1月至2020年12月。

结果

通过搜索识别出40篇论文。其中,纳入了7项RCTs。所有研究都使用标准化测量方法来评估HRQoL,即使并非总是针对CML特异性的。5项RCTs将受试者随机分为2组或3组,以评估第一代、第二代和第三代TKIs单药治疗的效果。2项RCTs将受试者随机分为TKI治疗加附加治疗组和常规TKI治疗组。对所有这些试验的结果进行了检查和讨论。

结论

所有纳入的RCTs都指出了关于TKIs对CML患者HRQoL的积极影响的重要发现,无论是在单药治疗中使用,还是特别是在加用附加治疗以增强TKIs效果时。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/537f/11037549/e327ce66f47e/CPEMH-19-e1745017921112200_F1.jpg

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