Abstract | PURPOSE: METHODS: Electronic databases searched through October 2008 identified 3,794 articles for initial screening. Eligibility included solid tumor or lymphoma patients randomly assigned to chemotherapy with or without G-CSF support, > or = 2 years of follow-up, and reporting AML/MDS or all second malignancies. Dual blinded data extraction was performed. Relative risk (RR) and absolute risk (AR) estimates +/- 95% CIs were calculated by the Mantel-Haenszel method. RESULTS: In the 25 eligible RCTs, 6,058 and 6,746 patients were randomly assigned to receive chemotherapy with and without initial G-CSF support, respectively. At mean and median follow-up across studies of 60 and 53 months, respectively, AML/MDS was reported in 22 control patients and 43 G-CSF-treated patients, with an estimated RR of 1.92 (95% CI, 1.19 to 3.07; P = .007) and AR increase of 0.41% (95% CI, 0.10% to 0.72%; P = .009). Deaths were reported in 1,845 patients randomly assigned to G-CSF and in 2,099 controls, for estimates of RR and AR decrease of 0.897 (95% CI, 0.857 to 0.938; P < .001) and 3.40% (95% CI, 2.01% to 4.80%; P < .001), respectively. Greater RR reduction for mortality was seen for both larger studies (P = .05) and greater chemotherapy dose-intensity (P = .012). CONCLUSION: Delivered chemotherapy dose-intensity and risk of AML/MDS are increased but all-cause mortality is decreased in patients receiving chemotherapy with G-CSF support. Greater reductions in mortality were observed with greater chemotherapy dose-intensity.
|
Authors | Gary H Lyman, David C Dale, Debra A Wolff, Eva Culakova, Marek S Poniewierski, Nicole M Kuderer, Jeffrey Crawford |
Journal | Journal of clinical oncology : official journal of the American Society of Clinical Oncology
(J Clin Oncol)
Vol. 28
Issue 17
Pg. 2914-24
(Jun 10 2010)
ISSN: 1527-7755 [Electronic] United States |
PMID | 20385991
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review, Systematic Review)
|
Chemical References |
- Granulocyte Colony-Stimulating Factor
|
Topics |
- Antineoplastic Combined Chemotherapy Protocols
(therapeutic use)
- Granulocyte Colony-Stimulating Factor
(therapeutic use)
- Humans
- Leukemia, Myeloid, Acute
(drug therapy)
- Meta-Analysis as Topic
- Myelodysplastic Syndromes
(drug therapy)
- Randomized Controlled Trials as Topic
- Treatment Outcome
|