Graft-versus-host disease prophylaxis after transplantation: a network meta-analysis.
<h4>Background</h4>Graft-versus-host Disease (GvHD) prophylaxis after allogeneic hematopoietic stem-cell transplantation (HSCT) is an ongoing effort but relative effects of different policies are not systematically explored.<h4>Methods</h4>We systematically reviewed 30-year e...
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Public Library of Science (PLoS)
2014-01-01
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| Online Access: | https://doi.org/10.1371/journal.pone.0114735 |
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| author | Panayiotis D Ziakas Fainareti N Zervou Ioannis M Zacharioudakis Eleftherios Mylonakis |
| author_facet | Panayiotis D Ziakas Fainareti N Zervou Ioannis M Zacharioudakis Eleftherios Mylonakis |
| author_sort | Panayiotis D Ziakas |
| collection | DOAJ |
| description | <h4>Background</h4>Graft-versus-host Disease (GvHD) prophylaxis after allogeneic hematopoietic stem-cell transplantation (HSCT) is an ongoing effort but relative effects of different policies are not systematically explored.<h4>Methods</h4>We systematically reviewed 30-year evidence on GvHD prophylaxis and quantified the relative effect of different policies using a network meta-analysis. We searched PubMed and the Cochrane Library for randomized studies on the topic. The primary outcome of interest was grade II-IV acute GvHD over 0 or I (with odds ratio OR <1 denoting benefit).<h4>Findings</h4>Thirty-three eligible studies that enrolled 3,440 patients (published up to June 2014), provided data on seven immunosuppressive drugs namely cyclosporin A (CsA), methotrexate (MTX), anti-thymocyte globulin (ATG), mycophenolate mofetil (MMF), tacrolimus, sirolimus or corticosteroids and their combinations to calculate 14 direct and 21 indirect effects. The majority of trials (32/33) referred to myeloablative conditioning and sibling transplants (25/33). Tacrolimus/MTX (OR 0.44; 95% 0.27-0.70, number needed to treat to benefit, i.e. to avert a case of II-IV GvHD, NNTB = 5) and ATG/CsA/MTX (OR 0.45; 95%CI 0.26-0.78; NNTB = 5) were superior over CsA/MTX. ATG/CsA/MTX did not differ from tacrolimus/MTX (indirect evidence). Sirolimus-based prophylaxis outperformed CsA/MTX (OR 0.10; 95%CI 0.02-0.49, NNTB = 4) and marginally outperformed tacrolimus/MTX (OR 0.22; 95%CI 0.05-1.11). Add-on corticosteroids had no benefit over CsA/MTX.<h4>Conclusions</h4>Tacrolimus/MTX and ATG/CsA/MTX were the outperformers over CsA/MTX, but sirolimus-based regimens showed also potential. More randomized data are needed for reduced-intensity conditioning, as well as for MMF and sirolimus-containing regimens. |
| format | Article |
| id | doaj-art-8c575a2f27bb4061ac6a331fad4d6c2d |
| institution | Kabale University |
| issn | 1932-6203 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj-art-8c575a2f27bb4061ac6a331fad4d6c2d2025-08-20T03:28:47ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-01912e11473510.1371/journal.pone.0114735Graft-versus-host disease prophylaxis after transplantation: a network meta-analysis.Panayiotis D ZiakasFainareti N ZervouIoannis M ZacharioudakisEleftherios Mylonakis<h4>Background</h4>Graft-versus-host Disease (GvHD) prophylaxis after allogeneic hematopoietic stem-cell transplantation (HSCT) is an ongoing effort but relative effects of different policies are not systematically explored.<h4>Methods</h4>We systematically reviewed 30-year evidence on GvHD prophylaxis and quantified the relative effect of different policies using a network meta-analysis. We searched PubMed and the Cochrane Library for randomized studies on the topic. The primary outcome of interest was grade II-IV acute GvHD over 0 or I (with odds ratio OR <1 denoting benefit).<h4>Findings</h4>Thirty-three eligible studies that enrolled 3,440 patients (published up to June 2014), provided data on seven immunosuppressive drugs namely cyclosporin A (CsA), methotrexate (MTX), anti-thymocyte globulin (ATG), mycophenolate mofetil (MMF), tacrolimus, sirolimus or corticosteroids and their combinations to calculate 14 direct and 21 indirect effects. The majority of trials (32/33) referred to myeloablative conditioning and sibling transplants (25/33). Tacrolimus/MTX (OR 0.44; 95% 0.27-0.70, number needed to treat to benefit, i.e. to avert a case of II-IV GvHD, NNTB = 5) and ATG/CsA/MTX (OR 0.45; 95%CI 0.26-0.78; NNTB = 5) were superior over CsA/MTX. ATG/CsA/MTX did not differ from tacrolimus/MTX (indirect evidence). Sirolimus-based prophylaxis outperformed CsA/MTX (OR 0.10; 95%CI 0.02-0.49, NNTB = 4) and marginally outperformed tacrolimus/MTX (OR 0.22; 95%CI 0.05-1.11). Add-on corticosteroids had no benefit over CsA/MTX.<h4>Conclusions</h4>Tacrolimus/MTX and ATG/CsA/MTX were the outperformers over CsA/MTX, but sirolimus-based regimens showed also potential. More randomized data are needed for reduced-intensity conditioning, as well as for MMF and sirolimus-containing regimens.https://doi.org/10.1371/journal.pone.0114735 |
| spellingShingle | Panayiotis D Ziakas Fainareti N Zervou Ioannis M Zacharioudakis Eleftherios Mylonakis Graft-versus-host disease prophylaxis after transplantation: a network meta-analysis. PLoS ONE |
| title | Graft-versus-host disease prophylaxis after transplantation: a network meta-analysis. |
| title_full | Graft-versus-host disease prophylaxis after transplantation: a network meta-analysis. |
| title_fullStr | Graft-versus-host disease prophylaxis after transplantation: a network meta-analysis. |
| title_full_unstemmed | Graft-versus-host disease prophylaxis after transplantation: a network meta-analysis. |
| title_short | Graft-versus-host disease prophylaxis after transplantation: a network meta-analysis. |
| title_sort | graft versus host disease prophylaxis after transplantation a network meta analysis |
| url | https://doi.org/10.1371/journal.pone.0114735 |
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