High-Dose Chemotherapy With Autologous Stem Cell Transplantation In The First Line Threatment Of Aggressive Non-Hodgkin's Lymphoma: A Meta-Analysis

Objective: To assess the effectiveness of high-dose chemotherapy with autologous stem cell transplantation in the first line treatment of patients with aggressive non-Hodgkin's lymphoma.Method: We searched Pubmed (1966.1-2010.10), Cochrane Library, Embase (1974.1-2010.10),CBM (1978.1-2010.10),CNKI (1994.1-2010.10) and handsearched some related Chinese Journals. We selected the randomized controlled trials comparing HDCT and conventional chemotherapy in the first line treatment of patients with aggressive NHL. The methodological quality of included studies was extracted according to Cochrane Handbook for Systematic Reviews. Meta-analysis was performed by Revman 5.0 sofeware. Outcomes included five-year overall survival, event-free survival, complete response.Results: Sixteen RCTs were identified including 3143 patients. The results of meta-analysis were listed as follows:â—‹1 There was no significant difference between HDCT and conventional chemotherapy on overall survival [OR=0.89,95%CI (0.77-1.03), P=0.12];â—‹2 There was significant difference between these two groups on event-free survival [OR=1.2, 95%CI (1.08-1.43), P=0.003];â—‹3 There was significant difference between these two groups on complete response [OR=1.20, 95%CI (1.01-1.43), P=0.03];â—‹4 In terms of high and high-intermediate aaIPI there was significant difference on event-free survival [OR=1.22, 95%CI (1.02-1.45), P=0.03].Conclusions: Compared to the conventional chemotherapy, high-dose chemotherapy with autologous stem cell transplantation in the first line treatment of aggressive non-Hodgkin's lymphoma can not improve patient's overall survival but worse to event-free survival and complete response. There is no conclusive evidence that high-dose chemotherapy with autologous stem cell transplantation is superior when compared to conventional chemotherapy in the first line treatment of patients with aggressive non-Hodgkin's lymphoma. So more high-quality, multiple-center, large-sample randomized controlled trials are required.