A review of the risks of long-term consequences associated with components of the CHOP chemotherapy regimen.

IF 2.4
Crystal Watson, Hemanth Gadikota, Arie Barlev, Rachel Beckerman
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引用次数: 4

Abstract

A common chemotherapy regimen in post-transplant lymphoproliferative disease (PTLD) following solid organ transplants (SOT) is cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). This study reviews the quantitative evidence for long-term consequences associated with components of CHOP identified from the Children's Oncology Group Long-Term Follow-Up Guidelines. Cited references were screened using prespecified criteria (English, systematic review, randomized controlled trial n > 100, observation study n > 100, case series n > 20). Relevant data were extracted and synthesized. Of 61 studies, 66% were retrospective cohort studies, 28% were in the US, and 95% enrolled pediatric patients. No study focused specifically on the CHOP regimen. Long-term consequences for CHOP components observed in >3 studies included cardiac toxicity (n = 14), hormone deficiencies/infertility (n = 14), secondary leukemia (n = 7), osteonecrosis (n = 6), and bladder cancer (n = 4). These effects are significant, impact a high percentage of patients, and occur as early as one year after treatment. Although none of the studies focused specifically on the CHOP regimen, 30%, 23%, and 15% evaluated alkylating agents (e.g. cyclophosphamide), anthracyclines (e.g. doxorubicin), and corticosteroids (e.g. prednisone), respectively. All three product classes had a dose-dependent risk of long-term consequences with up to 13.2-fold, 27-fold, 16-fold, 14.5-fold, and 6.2-fold increase in risk of heart failure, early menopause, secondary leukemia, bladder cancer, and osteonecrosis, respectively. Lymphoma patients had significantly elevated risks of cardiac toxicity (up to 12.2-fold), ovarian failure (up to 3.8-fold), and osteonecrosis (up to 6.7-fold). No studies were found in PTLD or SOT. Safe and effective PTLD treatments that potentially avoid these long-term consequences are urgently needed.

Abstract Image

Abstract Image

与CHOP化疗方案组成部分相关的长期后果风险综述。
实体器官移植(SOT)后移植后淋巴细胞增生性疾病(PTLD)的常见化疗方案是环磷酰胺、阿霉素、长春新碱和泼尼松(CHOP)。本研究回顾了儿童肿瘤组长期随访指南中确定的CHOP成分相关长期后果的定量证据。采用预先设定的标准筛选被引文献(英文、系统综述、随机对照试验n > 100、观察研究n > 100、病例系列n > 20)。提取并综合相关数据。在61项研究中,66%为回顾性队列研究,28%在美国,95%纳入儿科患者。没有专门针对CHOP方案的研究。在超过3项研究中观察到CHOP成分的长期后果包括心脏毒性(n = 14)、激素缺乏/不育(n = 14)、继发性白血病(n = 7)、骨坏死(n = 6)和膀胱癌(n = 4)。这些影响是显著的,影响很大比例的患者,并且早在治疗一年后就会发生。虽然没有一项研究专门关注CHOP方案,但分别有30%、23%和15%的研究评估了烷基化剂(如环磷酰胺)、蒽环类药物(如阿霉素)和皮质类固醇(如强尼松)。所有三种产品类别都具有剂量依赖性的长期后果风险,心力衰竭、早期绝经、继发性白血病、膀胱癌和骨坏死的风险分别增加13.2倍、27倍、16倍、14.5倍和6.2倍。淋巴瘤患者发生心脏毒性(高达12.2倍)、卵巢功能衰竭(高达3.8倍)和骨坏死(高达6.7倍)的风险显著升高。未发现PTLD或SOT的相关研究。迫切需要安全有效的PTLD治疗,以潜在地避免这些长期后果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Drug Assessment
Journal of Drug Assessment PHARMACOLOGY & PHARMACY-
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