Arsenic trioxide vs all-trans retinoic acid to treat acute promyelocytic leukemia: a systematic comparative review
- VernacularTitle:三氧化二砷与全反式维甲酸治疗急性早幼粒细胞白血病疗效比较的系统评价
- Author:
Shuangnian XU
;
Jieping CHEN
;
Jianping LIU
;
Yun XIA
- Publication Type:Journal Article
- Keywords:
arsenic trioxide;
acute promyelocytic leukemia;
randomized controlled trials;
systematic review
- From:Journal of Third Military Medical University
2003;0(21):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the efficacy and safety of arsenic trioxide ( ATO) with all-trans retinoic acid ( ATRA) for the treatment of acute promyelocytic leukemia ( APL) . Methods We searched the database of Cochrane Library ( Issue 1,2009) ,CENTRAL ( 1970 to 2009) ,Medline ( 1978 to 2008) ,EMBASE ( 1950 to 2009) ,CBM ( 1978 to 2008) ,CNKI ( 1994 to 2008) and CMAC ( 1994 to 2008) . We also searched the Meta register,Conference Proceedings of American Society of Hematology ( 1946 to 2008) and American Society of Clinical Oncology ( 2004 to 2008) on the internet for grey literature. We had searched the related journals in the library of Third Military Medical University,too. We included randomized controlled trials which compared ATO with ATRA for the treatment of APL. We adopt complete remission rate,overall survival rate, disease-free survival rate,time to complete remission,relapse rate,mortality and adverse reactions as result indicators. Data were entered and analyzed with the Cochrane review manager software ( Revman 5. 0) . Results Four eligible randomized controlled trials ( RCTs) were included ( n =243) . All the RCTs were methodologically graded as B. They all are focusing on the comparison of ATO monotherapy with ATRA monotherapy in treating newly diagnosed APL patients. Meta analysis showed that effect index for complete remission,2-year disease-free survival,time to complete remission,relapse rate and mortality was 0. 96 ( 0. 50,1. 86) ,2. 76 ( 0.71,10.66) ,-1.30 d ( -1.83,-0.78) ,0.86 ( 0.45,1.63) ,and 1.15 ( 0.45,2.95) ,respectively. All indicated no statistically significant difference. Effect index for incidence of liver dysfunction was 3. 03 ( 1. 25, 7. 37) ,which showed statistically significant difference between ATO group and ATRA group. Conclusion ATO is not superior to ATRA in treating newly diagnosed APL patients regarding complete remission,diseasefree survival rate,time to complete remission,relapse rate and mortality. What is worse,it will increase the incidence of liver dysfunction during treatment. Due to limitation of included trials,this conclusion need to be validated by further studies.
