Autologous stem cell transplantation for malignancy: a systematic review of the literature

A systematic review of the literature was undertaken to assess what publish ed evidence is currently available to support the increasing use of autolog ous stem cell transplantation (ASCT), and to evaluate the published data wi th regard to the comparative cost, of high-dose and conventional therapy. T he review aimed to identify all published, randomized controlled trials (RC Ts) comparing high-dose therapy (HDT) with ASCT versus conventional chemoth erapy (CC) in acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgki n's disease, multiple myeloma, and breast, lung, testicular and ovarian can cer. The review also aimed to identify all studies that had compared the co st of the two treatment strategies, Reports were identified by systematic s earches of Cancerlit, Embase and Medline, and handsearching of several conf erence proceedings. Where possible, pooled odds ratios (ORs) were calculate d according to the fixed-effect model. A total of 18 randomized trials were identified in acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgk in's disease, multiple myeloma, and breast, lung and testicular cancer. Tri als were generally small and no disease site had sufficient information to determine reliably whether high-dose therapy with autologous transplant is more effective than CC. Five studies were identified that compared the cost of the two treatments. These found the cost of HDT to be between one and f our times higher than that of CC. Further randomized trials are required. W here appropriate, these should include economic assessment and assessments of long-term toxicity.