Induction treatments for acute promyelocytic leukemia: a network meta-analysis

// Junjie Huang 1, * , Min Sun 2, * , Zitong Wang 3, * , Qiaoxia Zhang 1 , Jin Lou 1 , Yun Cai 1 , Weihong Chen 1 , Xin Du 1 1 Shenzhen Bone Marrow Transplantation Public Service Platform, Department of Hematology, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen 518000, China 2 Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China 3 The University of Sydney Medical School, Sydney, NSW 2006, Australia * These authors have contributed equally to this work Correspondence to: Xin Du, email: duxingz@medmail.com.cn Keywords: induction treatment, acute promyelocytic leukemia, network meta-analysis Received: May 03, 2016      Accepted: September 28, 2016      Published: October 04, 2016 ABSTRACT Background: 9 treatments for acute promyelocytic leukemia (APL) have been compared in many randomized controlled trials (RCT). The conclusions have been inconsistent and the purpose of this study is to conduct a network meta-analysis. Results: Rankings of event-free survival are ATRA+RIF (81.2%), ATRA+ATO (69.6%), ATO (50.6%). Rankings of complete remission are ATRA+RIF (79.3%), ATRA+ATO (64.8%), RIF (60.3%), ATO (55.9%). Rankings of avoiding differentiation syndromes are CT (84.3%), ATO (80.3%), RIF (71.6%), ATRA+RIF (49%), ATRA+ATO (40.8%). Methods: A total of 1,666 patients from 12 RCTs were enrolled. The frequentist method was used. Relative risks with 95% confidence intervals were calculated. We produced a network plot, a contribution plot, and a forest plot predictive intervals. The inconsistency factor, the surface under the cumulative ranking curve and the publication bias were evaluated. Conclusions: ATRA+ATO is eligible to be the first-line treatment for APL. ATRA+RIF is a prospective alternative to the first-line treatment. RIF or ATO should be reconsidered as another option for de novo APL.