Determining the Benefits of Chemotherapy for Achieving Complete Response in Patients with Untreated Advanced Stage Follicular Lymphoma: A Systematic Review and Meta-Analysis.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 290-290 ◽  
Author(s):  
Josiah N. Orina ◽  
Susan G. Moore ◽  
Mary Jo Lechowicz ◽  
Christopher R. Flowers
Keyword(s):  
Follicular Lymphoma ◽  
Watchful Waiting ◽  
Meta Analysis ◽  
Single Agent ◽  
Complete Response ◽  
Inclusion Criteria ◽  
First Line ◽  
Treatment Regimens ◽  
American Society ◽  
Meta Analyses

Abstract Background:Although advanced stage follicular lymphoma (FL) is considered incurable with standard therapy, and early institution of therapy has not demonstrated benefits over watchful waiting, novel strategies such as lymphoma vaccines and maintenance rituximab(R) provide opportunities for achieving prolonged disease-free intervals. Promoting the benefits of these strategies will depend upon improving the complete response rate(CR) with initial treatment. To date, the optimal first-line therapy remains undefined. To address this issue, we conducted a systematic literature review and meta-analyses comparing first-line chemotherapy regimens for FL. Methods:We searched the Cochrane Central Register of Controlled Trials (Cochrane Library Issue 1, 2003), MEDLINE (1/1966–6/2005), EMBASE (1/1980–7/2005), American Society of Hematology Annual Meeting abstracts (2002–2004), and American Society of Clinical Oncology Annual Meeting abstracts (1995–2005). Each search used combinations of the term follicular lymphoma and terms for medications and treatment regimens. Criteria for including studies were: Inclusion of patients with untreated stage III/IV FL; Intervention with chemotherapy and/or immunotherapy, radioimmunotherapy, or watchful waiting; Reporting in English of the following treatment outcome measures for patients with FL: CR/CR-unconfirmed, overall response rate (OR), and at least one form of survival data. Extracted data included pre-treatment disease status, treatment regimen, median follow-up time, progression free survival, overall survival, CR and OR. The following treatment strategies from peer-review publications were analyzed: single-agent fludarabine(F), fludarabine-combinations(F-com), single-agent alkylators(A), alkylator-combinations (without anthracycline), and anthracycline-combinations. In meta-analyses of selected studies, we utilized the Mantel-Haenszel (fixed effects model) and DerSimonain and Laird (random effects) methods to calculate the risk difference comparing treatment regimens’ CR/CRu to the spontaneous CR in patients undergoing watchful waiting (4.6%; Ardeshna et al. Lancet, 2003). Results:Over 1800 abstracts were reviewed yielding 37 reported treatments that met inclusion criteria and included 2709 patients. The benefits of initial chemotherapy for achieving CR are shown in Figure 1. Single-agent F and A had similar benefits, as did F-com and CHOP. Substantial heterogeneity existed among other alkylator and anthracycline combinations limiting their ability to be combined using meta-analysis. Overall, chemotherapy provided a 49% improvement in the chances of attaining CR (95% CI:41%–57%). Meta-analyses of single agent R and RCHOP showed CR of 26% (95% CI:18%–34%) and 74% (95% CI:65%–83%) respectively (Figure 1B). Insufficient numbers of studies met inclusion criteria to examine the benefits of adding R to other regimens. Conclusions:CHOP and F-com provide the greatest likelihood of achieving CR in untreated FL. This benefit is even greater in CHOP patients who receive R. Selection of an initial regimen for patients with FL will depend on patient-specific factors and future plans for other therapies. Figure Figure

Determining the Benefits of Rituximab + Chemotherapy for Patients with Untreated Follicular Lymphoma: A Comprehensive Meta-Analysis.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3330-3330 ◽  
Author(s):  
Josiah N. Orina ◽  
Christopher R. Flowers
Keyword(s):  
Follicular Lymphoma ◽  
Watchful Waiting ◽  
Meta Analysis ◽  
Single Agent ◽  
Inclusion Criteria ◽  
First Line ◽  
Treatment Regimens ◽  
First Line Therapy ◽  
American Society ◽  
Meta Analyses

Abstract Background: Current guidelines offer numerous options for initiating therapy in patients with untreated, advanced stage follicular lymphoma (FL). Selecting among these options that include watchful waiting, single-agent and combination chemotherapy, monoclonal antibodies, and radioimmunotherapy, remains challenging. Recent data suggest that chemotherapy combined with a monoclonal antibody may alter patterns of relapse and overall survival for pts with FL (Fisher, Blood 2004). While rituximab (R) chemotherapy combinations have become commonly used for untreated pts with FL, to date, the optimal first-line therapy remains undefined. To address this issue, we updated a systematic literature review and performed a meta-analysis of first-line therapy for untreated FL that examined the effect of various chemotherapy regimens combined with R on response rates and survival in patients with untreated FL. Methods: The comprehensive systematic review included searches the Cochrane Central Register of Controlled Trials (Cochrane Library Issue 1, 2003), MEDLINE (1/1996–6/2006), EMBASE (1/1980–7/2006), American Society of Hematology Annual Meeting abstracts (2002–2005), and American Society of Clinical Oncology Annual Meeting abstracts (1995–2006). Each database was searched using combinations of the term follicular lymphoma and the terms for medications and treatment regimens. Inclusion criteria for studies were as follows: 1) Inclusion of patients with untreated stage III/IV FL grades 1, 2, or 3; 2) Intervention with chemotherapy and/or immunotherapy, radioimmunotherapy, or watchful waiting; 3) Reporting in English of the following treatment outcome measures specifically for patients with FL: CR/CR-unconfirmed, overall response rate (OR), and at least one form of survival data. Abstracts subsequently published as papers were excluded. Extracted data included pre-treatment disease status, treatment regimen, median follow-up time, progression free survival, overall survival, CR and OR. The following treatment strategies from peer-review publications were analyzed: single agent R, R-CVP, R-CHOP, and fludarabine-combinations with R (R-Fcom). In meta-analyses of selected studies, we utilized the Mantel-Haenszel (fixed effects model) and DerSimonain and Laird (random effects) methods to calculate the risk difference comparing treatment regimens’ CR/CRu to the spontaneous CR in patients undergoing watchful waiting (4.6%; Ardeshna et al. Lancet, 2003). Results: In total, over 3135 abstracts were reviewed to identify 11 studies meeting the inclusion criteria for this analysis. These studies included data from 3144 patients. Only one study presenting CR data for R-CVP (36%, 95% confidence interval: 28%–44%) met inclusion criteria. The meta-analyses estimated the CR rate associated with single-agent R to be 30% (95% CI: 20%–40%), R-CHOP to be 62% (30%–94%), and R-Fcom to be 85% (76%–94%) (random effects; see Figure). Conclusions: R-CHOP and R-fludarabine combinations appear to produce the highest CR rates for untreated pts with FL. Meta-analysis can aid clinicians in therapeutic decision making as they weight the risks and benefits of various regimens for newly diagnosed pts. Figure Figure

A Systematic Review and Meta-Analysis of Radioimmunotherapy Consolidation for Untreated Patients with Follicular Lymphoma (FL)

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 101-101
Author(s):  
Adam C. Rose ◽  
Gia Garrett ◽  
Miray Seward ◽  
Pareen J Shenoy ◽  
Roy A Kucuk ◽  
...  
Keyword(s):  
Systematic Review ◽  
Maintenance Therapy ◽  
Follicular Lymphoma ◽  
Annual Meeting ◽  
Research Funding ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Cochrane Central Register ◽  
Inclusion Criteria ◽  
American Society

Abstract Abstract 101 Background: The disease course of FL is characterized by multiple relapses and progressively shorter response durations with subsequent therapies. As a result, numerous treatment strategies have been developed to reduce the risk of progression including consolidation with transplantation, radio-immunotherapy (RIT), or maintenance therapy with rituximab (R). At present, the optimal therapeutic strategy for FL patients (pts) remains undefined. R maintenance and RIT with an anti-CD20 antibody linked to iodine-131 (I131 Tositumomab) or to yttrium-90 (Y90-ibritumomab tiuxetan) have emerged as well tolerated treatments following induction. To quantify the benefits of consolidative RIT, we conducted a systematic review of the literature and a meta-analysis of selected studies. Methods: As part of a broader review, we searched the Cochrane Central Register of Controlled Trials (Cochrane Library Issue, 2011), MEDLINE (1/1966-6/2011), American Society of Hematology Annual Meeting abstracts (2004–2010), and American Society of Clinical Oncology Annual Meeting abstracts (2007–2010). Each database was searched using combinations of the term ‘follicular lymphoma' and the terms for treatment regimens. Inclusion criteria for studies were as follows: 1) reports on phase 2/3 studies; 2) n≥30; 3) previously untreated patients 4) treatment with RIT targeted at the CD20 antigen following an induction regimen; 5) original reporting in English of the following treatment outcome measures for pts with FL: CR/CR-unconfirmed, OR, and at least one form of survival data. Extracted data included pre-treatment disease status, pt characteristics, treatment regimen, progression free survival (PFS), overall survival (OS), complete response (CR) and overall response (OR). Pooled estimates of the CR rate, OR rate, 2-year PFS and 5-year PFS for pts treated with consolidative RIT were computed using DerSimonian and Laird random effects models. Results: Over 1136 records were reviewed with 8 studies meeting inclusion criteria with 556 patients. Between 1998 and 2007, pts were accrued at multiple sites in all but one study. Median ages ranged from 49–57 years with 41–61% male subjects, among the studies reporting gender. A weighted average of 97.2% of patients had stage III/IV disease with 73–98% pts having grade 1/2 disease, among those studies reporting histology. Among studies reporting this information, 19–44% of patients had abnormal LDH values, and 25–100% had bulky lymph nodes. CR rates ranged from 51% to 97%, 2-year PFS ranged from 65% to 86%, and 5-year PFS ranged from 38% to 67%. The pooled estimates of the CR rate and OR rate following consolidative RIT were 78% (95% CI 66%–87%) and 98% (95% CI 92.9%–99.5%), respectively (Figure A). The pooled estimates for the 2-year and 5-year PFS were 77.0% (95% CI 70.5–82.4%) and 56.0% (95% CI 41.9–69.2%), respectively (Figure B). Conclusions: This analysis suggests that consolidative RIT is beneficial to patients with previously untreated FL with meaningful CR rates and 5-year PFS. In addition, consolidative RIT compares favorably to maintenance therapy with R given after chemotherapy (ECOG 1496) in both 2-year PFS (77.0% vs. 73.5%) and 5-year PFS (56.0% vs. 46.4%), and needs to be compared to maintenance R following R-chemotherapy induction. Disclosures: Flowers: Genentech/Roche (unpaid): Consultancy; Celgene: Consultancy, Research Funding; Millennium/Takeda: Consultancy, Research Funding; Seattle Genetics: Consultancy; Novartis: Research Funding; Spectrum: Consultancy, Research Funding.

Systematic Review and Meta-Analysis of Radioimmunotherapy Regimens in Patients with Relapsed Follicular and Transformed Nonhodgkins Lymphomas.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3113-3113 ◽  
Author(s):  
Josiah N. Orina ◽  
Susan G. Moore ◽  
Mary Jo Lechowicz ◽  
Christopher R. Flowers
Keyword(s):  
Systematic Review ◽  
Follicular Lymphoma ◽  
Annual Meeting ◽  
Meta Analysis ◽  
Treatment Options ◽  
Response Rates ◽  
Inclusion Criteria ◽  
Cd20 Antibody ◽  
American Society ◽  
Hodgkin's Lymphomas

Abstract Background:Numerous treatment options are available to patients with relapsed follicular lymphoma(FL), ranging from watchful waiting to transplantation. At present, the optimal therapy for this patient population remains undefined. Single agent rituximab(R) and radioimmunotherapy(RIT) with anti-CD20 antibody linked to iodine-131 (I131 Tositumomab) or to yttrium-90 (Y90-ibritumomab tiuxetan) have emerged as well tolerated treatments for relapsed FL and other indolent B-cell non-Hodgkin’s lymphomas(NHL). In phase II and III trials, RIT has demonstrated higher rates of complete response(CR) and overall response(OR) in patients with relapsed FL. To quantify the benefit of RIT and compare this to R, We conducted a systematic review of the literature and a meta-analysis of selected studies. Methods:As part of a broader review, we searched the Cochrane Central Register of Controlled Trials (Cochrane Library Issue 1, 2003), MEDLINE (1/1966-6/2005), EMBASE (1/1980-7/2005), American Society of Hematology Annual Meeting abstracts (2002–2004), and American Society of Clinical Oncology Annual Meeting abstracts (1995–2005). Each database was searched using combinations of the term follicular lymphoma and the terms for medications and treatment regimens. Inclusion criteria for studies were as follows: 1)Inclusion of patients with relapsed FL; 2)Treatment with RIT targeted at the CD20 antigen; 3)Original reporting in English of the following treatment outcome measures for patients with FL and/or other indolent NHL: CR/CR-unconfirmed, OR, and at least one form of survival data. Extracted data included pre-treatment disease status, patient characteristics, treatment regimen, progression free survival, overall survival, CR and OR. We utilized the Mantel-Haenszel (fixed effects model) and DerSimonain and Laird (random effects) methods to calculate the risk difference comparing the rates of CR/CRu and OR with RIT to those observed with conjugated CD20 antibody. For randomized trials of RIT the comparator in analyses was the control group from the trial. For other trials, response rates with RIT were compared to those observed with R in relapsed FL (McLaughlin, JCO 1998). Results:Over 1800 records were reviewed with 10 articles meeting inclusion criteria with 245 patients. Nearly all studies of RIT were multi-institutional, accrued patients between 1995 and 2002, had a median patient age >50 years, and had 48%–68% male patients. Three studies did not specify the number of patients with indolent NHL by histological class. In the remainder, 65%–100% of patients had FL grade 1 or 2. The percentage of patients with FL grade 3 or transformed NHL ranged in studies from 0 to 25%. In comparison to unconjugated CD20 antibody, overall, RIT improved CR by 30% (95% CI:24%–37%) and improved OR by 42% (95% CI:35%–49%). I131- and Y90-based RIT had overlapping benefits. Conclusions:As suggested by the individual trials, RIT can improve the likelihood of response and CR compared with R. Selecting appropriate patients for RIT will require consideration of patient factors as well as future treatment options such as transplantation and maintenance therapy that may extend the benefits of these improved response rates. Figure Figure

Efficacy of treatments in children with relapsed/refractory acute lymphocytic leukemia (r/r ALL).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e22001-e22001
Author(s):  
Amber L Martin ◽  
Simu K. Thomas ◽  
Mariana Cota ◽  
Yanni Hao ◽  
Younan Zhang ◽  
...  
Keyword(s):  
Childhood Leukemia ◽  
Pediatric Patients ◽  
Meta Analysis ◽  
Safety Data ◽  
Complete Response ◽  
Lymphocytic Leukemia ◽  
First Line ◽  
Treatment Regimens ◽  
Pediatric All ◽  
New Treatments

e22001 Background: Pediatric ALL is the most common childhood leukemia, 20% of children relapse after initial complete response (CR) to first-line treatment and the 5-year overall survival (OS) of pediatric r/r ALL patients is only 30%. A systematic literature review (SLR) and meta-analysis (MA) were conducted to determine the effects of treatments for pediatric r/r ALL. Methods: EMBASE, MEDLINE, and CENTRAL databases were searched from 01/01/2000-12/31/2016 using keywords for r/r ALL paired with terms for pediatric patients and relevant treatments to identify studies reporting efficacy and safety data. Proceedings from 2015-2016 oncology conferences were also searched. Statistical analysis was limited to studies with comparable patient populations and treatment regimens. Random-effects MA of single-arm data were performed to determine the OS rate at 6 and 12 months, median OS, and the rate of CR (timepoint not reported) for pediatric r/r ALL patients treated with clofarabine + cyclophosphamide + etoposide (CCE). Results: The studies included in the review were heterogeneous and just five of the 46 studies identified by the SLR were similar enough for MA in terms of outcomes and populations (median age 8-14 years, median 2 prior lines of therapy). All five studies were single-arm studies evaluating CCE, a treatment with a pooled 6-month OS of 43.5% (95% CI: 32.6% - 55.1%), 1-year OS of 26.7% (95% CI: 17.5% - 38.3%), and pooled median OS of 5.2 (95% CI: 3.2 – 8.6) months. The CR rate was 43.2% (33.7% - 53.3%) across the five studies (timepoint not reported), and the rate was comparatively higher when analysis was limited to those with B-cell immunophenotype (56.3% [95% CI: 22.5% - 85.1%]). Conclusions: This is the first SLR and MA to be conducted on pediatric r/r ALL to date. Available evidence was heterogeneous and MA were only possible for single-arm trials examining CCE. Survival is poor in this population, as just over a quarter of patients receiving CCE were alive at 12 months, with median OS less than 6 months. CR rates were more promising but the lack of data on timepoint of assessment make the results difficult to interpret. New treatments are needed to better manage patients in this r/r population.

Anti PD-(L)1 in KRAS mutant advanced nsclcs: A meta-analysis of randomized controlled trials.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 9025-9025
Author(s):  
Thierry Landre ◽  
Gregoire Justeau ◽  
Jean-baptiste Assié ◽  
Kader Chouahnia ◽  
Chérifa Taleb ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Single Agent ◽  
Progression Free Survival ◽  
Second Line ◽  
Wild Type ◽  
First Line ◽  
Free Survival ◽  
Randomized Controlled ◽  
Meta Analyses ◽  
Review Manager

9025 Background: KRAS comprise the most frequently found oncogene driver mutation in non-small cell lung cancer (NSCLC), accounting for 20-25% of these patients. Single-agent Anti PD-(L)1 clinical efficacy against KRAS mutant NSCLC is a topic of debate. Methods: This meta-analysis examined randomized-trial data comparing first-or second line Anti PD-(L)1 +/- chemotherapy (CT) vs CT alone for KRAS mutant advanced NSCLCs. Outcome measures included overall survival (OS) and progression-free survival (PFS). Analyses were computed using the Cochrane method of collaboration for meta-analyses, with Review Manager software (RevMan version 5.3; Oxford, UK). Results: We analyzed 3 trials in first line (IMPOWER-150, KEYNOTE-189 and KEYNOTE-042), as well as 3 trials in second line (OAK, POPLAR and CHECKMATE-057) including 1313 NSCLCs (386 KRAS mutant and 927 KRAS wild-type tumor). Anti PD-(L)1 +/- CT was significantly associated (hazard ratio [95% confidence interval]) with prolonged OS (0.59 [0.49-0.72]; p < 0.00001) and PFS (0.58 [0.43-0.78]; p = 0.0003) compared to CT alone in KRAS mutant NSCLCs. Survival benefits occured in both first and second line. Survival benefits observed in KRAS wild-type NSCLCs were (0.87 [0.76-0.99]; p = 0.03) and (0.79 [0.56-1.11]; p = 0.17) respectively. OS benefit in KRAS mutant was significantly superior compared to OS benefit in KRAS wild-type (p = 0,001). Conclusions: Anti PD-(L)1 (+/- CT) appears superior to CT alone both for mutant and wild-type KRAS in advanced NSCLCs for OS and PFS with higher magnitude of benefit in KRAS mutated group for OS.

scholarly journals Osteoarthritis, mobility-related comorbidities and mortality: an overview of meta-analyses

2020 ◽  
Vol 12 ◽  
pp. 1759720X2098121
Author(s):  
Gustavo Constantino de Campos ◽  
Raman Mundi ◽  
Craig Whittington ◽  
Marie-Josée Toutounji ◽  
Wilson Ngai ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Ischemic Attack ◽  
Meta Analyses ◽  
The Relationship ◽  
Related Mortality

Aims: The objective of this review was to examine the relationship between osteoarthritis (OA) and mobility-related comorbidities, specifically diabetes mellitus (DM) and cardiovascular disease (CVD). It also investigated the relationship between OA and mortality. Methods: An overview of meta-analyses was conducted by performing two targeted searches from inception to June 2020. The association between OA and (i) DM or CVD ( via PubMed and Embase); and (ii) mortality ( via PubMed) was investigated. Meta-analyses were selected if they included studies that examined adults with OA at any site and reported associations between OA and DM, CVD, or mortality. Evidence was synthesized qualitatively. Results: Six meta-analyses met inclusion criteria. One meta-analysis of 20 studies demonstrated a statistically significant association between OA and DM, with pooled odds ratio of 1.41 (95% confidence interval: 1.21, 1.65; n = 1,040,175 patients). One meta-analysis of 15 studies demonstrated significantly increased risk of CVD among OA patients, with a pooled risk ratio of 1.24 (1.12, 1.37, n = 358,944 patients). Stratified by type of CVD, OA was shown to be associated with increased heart failure (HF) and ischemic heart disease (IHD) and reduced transient ischemic attack (TIA). There was no association reported for stroke or myocardial infarction (MI). Three meta-analyses did not find a significant association between OA (any site) and all-cause mortality. However, OA was found to be significantly associated with cardiovascular-related death across two meta-analyses. Conclusion: The identified meta-analyses reported significantly increased risk of both DM and CVD (particularly, HF and IHD) among OA patients. It was not possible to confirm consistent directional or causal relationships. OA was found to be associated with increased mortality, but mostly in relation to CVD-related mortality, suggesting that further study is warranted in this area.

scholarly journals SYSTEMIC FRONT LINE THERAPY OF FOLLICULAR LYMPHOMA: WHEN, TO WHOM AND HOW

2016 ◽  
Vol 8 ◽  
pp. e2016062 ◽  
Author(s):  
Francesca Pavanello ◽  
Sara Steffanoni ◽  
Michele Ghielmini ◽  
Emanuele Zucca
Keyword(s):  
Monoclonal Antibodies ◽  
Follicular Lymphoma ◽  
Target Therapy ◽  
Single Agent ◽  
New Drugs ◽  
Response To Treatment ◽  
Line Treatment ◽  
First Line ◽  
Line Therapy ◽  
First Line Treatment

The natural history of follicular lymphoma is usually characterized by an indolent course with a high response rate to the first line therapy followed by recurrent relapses, with a time to next treatment becoming shorter after each subsequent treatment line. More than 80% of patients have advanced stage disease at diagnosis. The time of initiation and the nature of the treatment is mainly conditioned by symptoms, tumor burden, lymphoma grading, co-morbidities and patients preference. A number of clinical and biological factors have been determined to be prognostic in this disease, but the majority of them could not show to be predictive of response to treatment, and therefore can’t be used to guide the treatment choice. CD20 expression is the only predictive factor recognized in the treatment of FL and justifies the use of “naked” or “conjugated” anti-CD20 monoclonal antibodies as single agent or in combination with chemo- or targeted therapy. Nevertheless, as this marker is almost universally found in FL, it has little role for the choice of treatment. The outcome of patients with FL improved significantly in the last years, mainly due to the widespread use of rituximab, autologous and allogeneic transplantation in young and fit relapsed patients, the introduction of new drugs and the improvement in diagnostic accuracy and management of side effects. Agents as new monoclonal antibodies, immuno-modulating drugs and target therapy have recently been developed and approved for the relapsed setting, while studies to evaluate their role in first line treatment are still ongoing. Here we report our considerations on first line treatment approach and on the potential factors which could help in the choice of therapy.

Intra-arterial chemotherapy for retinoblastoma: an updated systematic review and meta-analysis

2019 ◽  
Vol 11 (12) ◽  
pp. 1266-1272 ◽  
Author(s):  
Krishnan Ravindran ◽  
Lauren A Dalvin ◽  
Jose S Pulido ◽  
Waleed Brinjikji
Keyword(s):  
Metastatic Disease ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
First Line ◽  
Short Term ◽  
Systemic Complications ◽  
Substantial Heterogeneity ◽  
Insight Into

Background and purposeIntra-arterial chemotherapy for retinoblastoma has been adopted as a first-line treatment option by numerous tertiary centers. The effect of intra-arterial chemotherapy on future rates of metastatic disease as well as on globe salvage in advanced eyes remains relatively unknown.MethodsA search of PubMED, MEDLINE, EMBASE, and Web of Science electronic databases was conducted from inception until January 2019 for studies with a minimum of 10 patients reporting outcomes and complications following intra-arterial chemotherapy for retinoblastoma.ResultsA total of 20 studies met the inclusion criteria for analysis, comprising 873 patients and 1467 eyes. Only one study was comparative; there was substantial heterogeneity in reported outcomes and several overlapping patient cohorts that were published. Across all studies, 174 of 1467 eyes were enucleated (11.8%). Metastatic disease occurred in 8 of 513 patients (1.6%). Globe salvage was achieved in 318 of 906 (35.6%) cases of advanced retinoblastoma. The most common ocular complication was retinal detachment, occurring in 23% of eyes, and the most common systemic complications were transient fever and nausea/vomiting.ConclusionsThere is a paucity of higher-level evidence with adequate follow-up surrounding the long-term safety of intra-arterial chemotherapy and effect on metastasis in retinoblastoma. Studies to date have been limited by short-term follow-up. Longitudinal prospective studies could provide greater insight into the ability of intra-arterial chemotherapy to reduce the risk of retinoblastoma metastasis.

Sensorineural hearing loss with macrolide antibiotics exposure: a meta-analysis of the association

2020 ◽  
Author(s):  
Yazed Saleh Alsowaida ◽  
Abdulaziz Saleh Almulhim ◽  
Mok Oh ◽  
Brian Erstad ◽  
Ivo Abraham
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Sensorineural Hearing ◽  
Cochrane Library ◽  
Macrolide Antibiotics ◽  
Random Effects Model ◽  
Inclusion Criteria ◽  
Meta Analyses

Abstract Objective Macrolide antibiotics are among the most commonly used antibiotics; the association of macrolide antibiotics exposure with sensorineural hearing loss (SNHL) has been hypothesized. A systematic search was conducted in PubMed, EMBASE and Cochrane Library from inception to 15 July 2019 to identify studies used macrolide antibiotics for any indication. The results were reported as odds ratio (OR) with 95% confidence interval (CI) using random-effects model to derive the association of macrolide antibiotics exposure with SNHL. The objective of this meta-analysis was to estimate the association of macrolide antibiotics exposure and SNHL from up-to-date evidence. Key findings Nine studies met the inclusion criteria. There was no statistically significant association between macrolide antibiotics exposure and SNHL; the OR was 1.20 (95% CI: 0.96 to 1.49). No significant association was found with any of the subgroup meta-analyses. Summary Whilst the frequency of SNHL was higher with macrolide antibiotics exposure compared with controls, overall, no association was found between macrolide antibiotics and SNHL.

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