| Objective To systematically review the effectiveness and safety of 6-thioguanine versus 6-mercaptopurine in childhood acute lymphoblastic leukemia(ALL). Methods Randomized controlled trials(RCTs) about 6-TG in treating children with ALL were searched electronically in Chinese Database of CBM, CNKI, VIP, and WanFang Data,and English Database of The Cochrane Library, PubMed, EMbase, and Web of Science, ScienceDirect. Three reviewers screened literature, extracted data, and assessed methodological quality of the included studies according to the inclusion and exclusion criteria independently. Meta-analysis was performed using RevMan5.3software. Results All randomized trials of 6-TG versus 6-MP in children with ALL were sought, a total of 3 studies involving 3993 patients were finally included. The results of meta-analysis showed that 6-TG improved the overall relapse[OR=0.80,95%CI(0.67, 0.94), P=0.008]. However, death in the first remission[OR=1.78,95%CI(1.05, 3.02), P=0.03]were not significantly improved with 6-TG. Besides,HOVD was only discovered in the children randomized to 6-TG, and most of the patients of 6-TG suffered from thrombocytopenia. Conclusion Current evidence suggests that 6-TG may be more effective in preventing relapse of childhood ALL,but it causes excess toxicity without overall benefit. At present, we suggest that mercaptopurine remains the standard thiopurine of choice. |
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