Research Of Maintenance Therapy For Childhood Leukemia Recommended By Domestic And International Clinical Practice Guidelines

Objective To assist clinical pediatricians to better understand and use the latest guidelines,this study analyzed domestic and international guidelines for the management of acute lymphoblastic leukemia(ALL)published in journals or online in the past five years.Methods ALL guidelines,consensus or treatment protocols published from January 1,2015 to March 7,2021 were included.A literature search was conducted in Chinese in Medical Pulse,CNKI,Wanfang Data,CBM,and Wipu databases,and in English in MEDLINE,Embase,Google Scholar,and Cochrane library.The leukemia guidelines currently published in domestic and international journals were analyzed and evaluated using the internationally used guideline evaluation tools AGREE II and RIGHT checklist.Maintenance treatment regimens of domestic and foreign guidelines were compared,and clinical trials using treatment regimens from the guidelines were systematically evaluated.Results After a systematic search,1,164 records were initially retrieved and 7 guidelines were finally included by reading the title and abstract and full text.Three(42.9%)guidelines each were developed in China and the United States,with 42.9%of the guidelines for children.The mean score of AGREE evaluation was 45.7%,and the methodological quality of foreign guidelines was significantly higher than that of Chinese guidelines(MD=-0.26,95%CI[-0.37 to-0.14]),with the highest methodological quality of US guidelines(mean score=66.1%)in the area of developmental rigor the US guidelines scored 5.3 times higher than the Chinese guidelines.When analyzing the quality of guideline reporting,the total reporting rate of the seven guidelines was 47.3%,and the quality of reporting was higher for the Society-published guidelines(MD=0.27,95%Cl[0.09-0.46]).trial results from the clinical CCCG-ALL 2008 and CCCG-ALL-2015 protocols showed similar mortality rates in children(4.53%vs.5.29%).A comprehensive analysis of maintenance regimens from both national and international guidelines prioritizes the use of 6-mercaptopurine,methotrexate,and vincristine with glucocorticoids or other drugs.For glucocorticoids,NCCN guidelines recommend prednisone,while domestic guidelines mainly recommend dexamethasone or the combination of vincristine and dexamethasone.Conclusions The ALL guidelines developed abroad are of higher quality,but are obscure and difficult to understand due to the amount of information available when reading them.It is recommended that the guidelines developers issue a simplified version that facilitates the dissemination and implementation of the guidelines.The current guidelines in China are in a loose form.It is recommended that guideline developers refer to international standards and develop high-quality clinical guidelines that are suitable for Chinese reading habits and meet international standards.