Garside R, Round A, Stein K, Dalziel K; International Society of Technology Assessment in Health Care. Meeting (19th : 2003 : Canmore, Alta.).
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 2003; 19: abstract no. 203.
Peninsula Medical School, Universities of Plymouth and Exeter, Dean Clarke House, Southernhay East, Exeter, EX1 1PQ UK E-mail: R.Garside@ex.ac.uk
OBJECTIVES: To assess the effectiveness of drug treatment for CML in late stage disease (accelerated and blast phases). METHODS: A systematic review of the literature was undertaken to obtain all RCTs, controlled trials and observational studies relating to drug therapy for CML. Formal meta-analysis was not possible so the results were presented descriptively and the survival curves of five drug regimens reported by the RCT, a controlled study and case series (imatinib mesylate) were plotted on the same axis for comparison. RESULTS: The search identified one RCT and 14 case series. A range of chemotherapy regimens were identified, including mild chemotherapy alternatives as well as combinations of toxic drugs with adverse event profiles. Those studies supplying survival curves were re-plotted on the same axis as shown below. DISCUSSION: Late phase CML is resistant to treatment and survival expectations are short. It has attracted little attention in the literature. A range of toxic, costly chemotherapy regimens are being used in the terminal phase of illness although little experimental evidence has been published and survival expectations have changed little over the last 20 years. A visual presentation of the evidence suggests that more toxic regimens are no more effective than those with less adverse effects, underlying the importance of patient relevant outcomes being assessed. Imatinib seems to offer modest survival improvement but the level of evidence is weak. Difficulties reaching conclusions where there is limited evidence and the use of indirect comparisons will be discussed.
Publication Types:
Keywords:
- Blast Crisis
- Case-Control Studies
- Humans
- Pharmaceutical Preparations
- Piperazines
- Protein-Tyrosine Kinases
- Proto-Oncogene Proteins
- Pyrimidines
- drug therapy
- imatinib
- therapy
- hsrmtgs
Other ID:
UI: 102276121
From Meeting Abstracts