title: Intensified therapy followed by autologous stem-cell transplantation (ASCT) versus conventional therapy as first-line treatment of follicular lymphoma: a meta-analysis.
abstract: There are two different international standards for the treatment of follicular lymphoma (FL): intensified therapy followed by autologous stem-cell transplantation (ASCT) and conventional therapy in the first-line setting. However, their role remains unclear. Our aim was to define the treatment effect of intensified therapy followed by ASCT compared with conventional therapy as first-line treatment of patients with FL in terms of overall survival (OS) and event-free survival (EFS). We searched for randomised controlled trials in Medline, Embase, the Cochrane controlled trials register and the Science Citation Index (1985 to June 2011). Effect measures used were hazard ratios (HR) for OS, EFS and secondary tumour rate. Two independent review authors extracted data and assessed quality of trials. Four trials were identified, covering a total of 941 subjects. The random-effects summary HR by comparing the treatment effect on OS between intensified and conventional therapy was 0.95 [0.70, 1.30] (p = 0.75), indicating that no additional survival benefit was derived from the intensified therapy followed by ASCT. A significant benefit of intensified therapy followed by ASCT as first-line treatment was detected in terms of EFS: the random-effects summary HR (intensified versus conventional therapy) was 0.59 [0.44, 0.79] (p < 0.001). This meta-analysis showed that despite its superior EFS, intensified therapy followed by ASCT does not improve the OS compared with conventional therapy.
authors.affiliation: Department of Hematology, Weifang People's Hospital, Shandong, Weifang, 261041, China.
authors.forename: Baohong
authors.initials: B
authors.lastname: Wang
authors.forename: Cuiai
authors.initials: C
authors.lastname: Ren
authors.forename: Weide
authors.initials: W
authors.lastname: Zhang
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Ma
authors.forename: Bingsen
authors.initials: B
authors.lastname: Xia
authors.forename: Zhixin
authors.initials: Z
authors.lastname: Sheng
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002330:Carmustine / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage; D008224:Lymphoma, Follicular / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000139:chemically induced / Q000453:epidemiology; D011241:Prednisone / Q000008:administration & dosage; D011994:Recombinant Proteins / Q000008:administration & dosage; D012074:Remission Induction; D016019:Survival Analysis; D013713:Teniposide / Q000008:administration & dosage; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage; D014916:Whole-Body Irradiation
chemical_list: D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D003561:Cytarabine; D014750:Vincristine; D005047:Etoposide; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D013713:Teniposide; D002945:Cisplatin; D008558:Melphalan; D002330:Carmustine; D011241:Prednisone