Hertenstein B, Heil G, Heimpel H
Department of Internal Medicine II, University of Ulm, Germany.
Ann Hematol. 1996 Apr;72(4):223-30. doi: 10.1007/s002770050164.
The methodology of decision analysis was originally developed to improve clinical decisions of physicians for individual patients. However, it is also well suited to support consensus procedures. We have used this methodology to analyse the question whether allogeneic bone marrow transplantation (BMT) or consolidation chemotherapy (CCT) should be used as first line postremission treatment in patients with acute myeloid leukemia. Main risk factors relevant for the outcome after BMT and CCT are therapy-related mortality and leukemic relapse, respectively. If the possibility of salvage BMT for patients relapsing after CCT is included, the outcomes of the two strategies come rather close. However, they are clearly different in subtypes of leukemia with high or low risk of relapse, and in patients at high risk for BMT-related mortality. Sensitivity analysis considering the variation of more than one risk factor provides valuable information for decision making for both individual patients and particular subgroups of patients with acute myeloid leukemia.
决策分析方法最初是为改善医生针对个体患者的临床决策而开发的。然而，它也非常适合支持达成共识的程序。我们已使用该方法来分析一个问题，即对于急性髓系白血病患者，异基因骨髓移植（BMT）或巩固化疗（CCT）是否应用作缓解后一线治疗。与BMT和CCT后结局相关的主要风险因素分别是治疗相关死亡率和白血病复发。如果将CCT后复发患者进行挽救性BMT的可能性考虑在内，两种策略的结局相当接近。然而，在复发风险高或低的白血病亚型以及BMT相关死亡率高的患者中，它们明显不同。考虑多个风险因素变化的敏感性分析为急性髓系白血病个体患者和特定患者亚组的决策提供了有价值的信息。
