High-dose chemotherapy followed by autologous stem cell transplantation for XXXX --a systematic review.

@entity1 @entity980 @entity2101 @entity3
INTRODUCTION: @entity1 with @entity3 ( @entity980 ) have a poor prognosis. The aim of this systematic review is to investigate whether @entity2101 ( @entity2101 ) followed by autologous hematopoietic stem cell transplantation (HSCT) in @entity1 with metastatic @entity980 has additional benefit or harm compared to standard chemotherapy. METHODS: Systematic literature searches were performed in MEDLINE, EMBASE, and The Cochrane Library. All databases were searched from inception to February 2010. PubMed was searched in June 2010 for a last update. In addition to randomized and non-randomized controlled trials, case series and case reports were included to complement results from scant data. The primary outcome was overall survival. A meta-analysis was performed using the hazard ratio as primary effect measure, which was estimated from Cox proportional hazard models or from summary statistics of Kaplan Meier product-limit estimations. RESULTS: A total of 40 studies with 287 transplant @entity1 with metastatic @entity980 (age range 0 to 32 years) were included in the assessment. We identified 3 non-randomized controlled trials. The 3-year overall survival ranged from 22% to 53% in the transplant groups vs. 18% to 55% in the control groups. Meta-analysis on overall survival in controlled trials showed no difference between treatments. Result of meta-analysis of pooled individual survival data of case series and case reports, and results from uncontrolled studies with aggregate data were in the range of those from controlled data. The risk of bias was high in all studies due to methodological flaws. CONCLUSIONS: @entity2101 followed by autologous HSCT in @entity1 with @entity980 remains an experimental treatment. At present, it does not appear justifiable to use this treatment except in appropriately designed controlled trials.
