Objective To evaluate the efficacy of bisphosphonates in treating patients with Multiple Myeloma. Methods The databases including The Cochrane Library, PubMed, EMBASE, CBM, and CNKI were searched. Quality assessment and data extraction were conducted by two reviewers independently, and disagreement, if any, was resolved by discussion. Meta-analyses were performed for homogeneous studies. Results Eleven RCTs were included, all of which came from abroad. The methodological quality of the included studies was good. The baseline data of each trial were comparable. Meta-analyses showed that, the pooled analysis of the published evidence demonstrated the beneficial effect of bisphosphonates on prevention of pathological vertebral fractures (OR=0.59, 95%CI 0.45 to 0.78, P=0.000 1) and on relieving pain (OR=0.59, 95%CI 0.46 to 0.76, P=0.000 05). However, the analysis of the effect of bisphosphonates on pain was based on clinically heterogeneous data which must be interpreted with caution. Meanwhile, there was no significant effect of bisphosphonates on mortality (OR=0.99, 95%CI 0.88 to 1.12, P=0.9) and hypercalcemia (OR=0.76, 95%CI 0.56 to 1.03, P=0.07). Conclusions Adding bisphosphonates to the treatment of myeloma can reduce pathological vertebral fractures and pain, but is not helpful to mortality and hypercalcemia.
Objective To assess the effectiveness and safety of erythropoietin (EPO) for cancer-related malignant anemia without radiotherapy or chemotherapy. Methods Randomized controlled trials (RCTs) or quasi-randomized controlled trials (quasi-RCTs) involving erythropoietin in the treatment of cancer-related malignant anemia were searched and identified from PubMed (1966 to Sept. 2009), EMBASE (1974 to Sept. 2009), The Cochrane Library (Issue 3, 2009), CBM (1978 to Sept. 2009), CNKI (1994 to Sept. 2009), VIP (1989 to Sept. 2009). We also handsearched relevant journals. Data were extracted and evaluated by two reviewers independently with specially designed extraction form. We evaluated the quality of the included studies by the Cochrane Handbook 5.0 recommend standard and analyzed data by Cochrane Collaboration’s RevMan 5.0. Results We included twelve trials. The quality of the included studies was poor. The grade of ten studies was B, and the grade of two studies was C. Meta-analyses showed that there were significant differences between erythropoietin and blank in volume of blood transfusion [SMD= –0.66, 95%CI (–1.14, –0.17), P=0.008], number need to transfusion [OR=0.60, 95%CI (0.39, 0.92), P=0.02], and the change of hemoglobin after two-week therapy [SMD=2.40, 95%CI (0.29, 4.52), P=0.03]. Conclusion The current evidence shows that EPO significantly benefits cancer-related malignant anemia. Well-designed RCTs with a larger sample size, longer intervention and follow-up periods are still needed.
Objective To asses the clinical effectiveness and safety of combined treatment with antilymphocyte globulin (ATG) and cyclosporine A (CSA) versus antilymphocyte globulin alone in patients with aplastic anemia (AA). Methods Randomized controlled trials (RCTs) were identified from MEDLINE (1966 to September 2007), EMBASE (1984 to September 2007), The Cochrane Library (issue 4, 2007) and CBM-disc (1978 to September 2007). The references of eligible studies were hand searched. RCTs involving ATG and CSA in the treatment of AA were included. Data were evaluated and extracted by two reviewers independently with designed extraction form. The Cochrane Collaboration’ s RevMan 4.2.10 software was used for data analyses. Results Two RCTs involving 160 patients were included. Two studies showed that the effective rate in the ATG+CSA group was significantly higher than that in the ATG group (Plt;0.0001). Two studies indicated that the survival rate in the ATG+CSA group was improved compared with the ATG group (P=0.0002). One study reported adverse effect. The ATG group caused more fever and serum diseases compared with the ATG+CSA group, but the ATG+CSA group had a higher incidence of hepatotoxicity. Conclusion Treatment with ATG+CSA for aplastic anemia has higher effective rate and survival rate than ATG alone. More trials of high quality are required.