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Comparative effectiveness of different chemotherapy regimens of advanced-stage Hodgkin lymphoma in adults: a network meta-analysis

Authors Zhang T, Yao Y, Feng F, Zhao W, Tian J, Zhou C, Wang X, Dong S, Li J, Qi L, Sun C

Received 6 July 2018

Accepted for publication 1 September 2018

Published 22 November 2018 Volume 2018:10 Pages 6017—6028

DOI https://doi.org/10.2147/CMAR.S179356

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Antonella D'Anneo


Tingting Zhang,1 Yan Yao,2 Fubin Feng,3 Wenge Zhao,2 Jinhui Tian,4 Chao Zhou,3 Xue Wang,5 Shengjie Dong,6 Jia Li,2 Lingyu Qi,7 Changgang Sun3,8

1College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, People’s Republic of China; 2Clinical Medical College, Weifang Medical University, Weifang, Shandong Province, People’s Republic of China; 3Department of Oncology, Weifang Traditional Chinese Hospital, Weifang, Shandong Province, People’s Republic of China; 4Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu Province, People’s Republic of China; 5Clinical Medical Colleges, Qingdao University, Shinan District, Qingdao, Shandong Province, People’s Republic of China; 6Department of the Joint and Bone Surgery, Yantaishan Hospital, Yantai, Shandong Province, People’s Republic of China; 7College of First Clinical Medicine, Shandong University of Traditional Chinese Medicine, Ji’nan, People’s Republic of China; 8Department of Oncology, Affiliated Hospital of Weifang Medical University, Kuiwen District, Weifang, Shandong Province, People’s Republic of China

Background:
Combined chemotherapy is the cornerstone treatment for patients with advanced Hodgkin lymphoma (HL). The objective of our study was to perform a network meta-analysis of the efficacy of different chemotherapy regimens in adults with advanced-stage HL.
Materials and methods: We searched for relevant randomized controlled trials (RCTs) in titles/abstracts in PubMed, Embase, and the Cochrane Library. The search was last updated on April 3, 2018. RCTs that assessed the effectiveness of one of the following treatments were included: doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD); four cycles of increased dose of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPPescalated) followed by two or four cycles of standard dose of BEACOPP (4× BEACOPPescalated + 2 or 4× BEACOPPbaseline); brentuximab vedotin plus doxorubicin, vinblastine, and dacarbazine (A+AVD); doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, and prednisone combined with radiation therapy (Stanford V); mechlorethamine (cyclophosphamide), vincristine, procarbazine, and prednisone (M[C]OPP); sequential or alternating chemotherapy regimens with ABVD as the footstone (eg, COPP/ABVD or mechlorethamine, vincristine, procarbazine, and prednisone [MOPP]/ABVD); eight cycles of BEACOPPescalated; hybrid MOPP/ABV; and M[C]EC (M[C]OPP with epidoxorubicin, bleomycin, vinblastine [EBV], and lomustine, doxorubicin, and vindesine [CAD]).
Results: Overall, we screened 3,564 citations and deemed 18 reports of 16 trials eligible and included them in our network meta-analysis. A total of 11,928 participants were randomly assigned to one of the 12 combinations of chemotherapy regimens, of which 11,476 participants were analyzed. For the overall survival (OS), no differences were observed within any interventions when the ABVD regimen was used as the reference treatment. Similarly, relative to A+AVD, 8× BEACOPPescalated and 6× BEACOPPescalated also showed no differences (HR =1.07, 95% credible interval (CrI): 0.58–1.95; HR =0.62, 95% CrI: 0.16–1.83; and HR =0.71, 95% CrI: 0.30–1.72, respectively). In terms of complete remission (CR), enough evidence exists to support a maximum clinical treatment effect for 6× BEACOPPescalated (OR =1.88, 95% CrI: 1.20–2.96; and OR =3.43, 95% CrI: 1.87–6.24).
Conclusion: When compared across the 12 combined chemotherapy regimens, six cycles of BEACOPPescalated may be the optimal treatment for patients with advanced-stage HL.

Keywords:
advanced-stage Hodgkin lymphoma, combined chemotherapy, overall survival, network meta-analysis, randomized controlled trial

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