文章基本信息
- 标题：Assessment of the consistency and robustness of results from a multicenter trial of remission maintenance therapy for acute myeloid leukemia
- 本地全文：下载
- 作者：Marc Buyse ; Pierre Squifflet ; Kathryn J Lucchesi 等
- 期刊名称：Trials
- 印刷版ISSN：1745-6215
- 电子版ISSN：1745-6215
- 出版年度：2011
- 卷号：12
- 期号：1
- 页码：86
- DOI：10.1186/1745-6215-12-86
- 语种：English
- 出版社：BioMed Central
- 摘要：
Background
Data from a randomized multinational phase 3 trial of 320 adults with acute myeloid leukemia (AML) demonstrated that maintenance therapy with 3-week cycles of histamine dihydrochloride plus low-dose interleukin-2 (HDC/IL-2) for up to 18 months significantly improved leukemia-free survival (LFS) but lacked power to detect an overall survival (OS) difference.
Purpose
To assess the consistency of treatment benefit across patient subsets and the robustness of data with respect to trial centers and endpoints.
Methods
Forest plots were constructed with hazard ratios (HRs) of HDC/IL-2 treatment effects versus no treatment (control) for prospectively defined patient subsets. Inconsistency coefficients (I2) and interaction tests (X2) were used to detect any differences in benefit among subsets. Robustness of results to the elimination of individual study centers was performed using "leave-one-center-out" analyses. Associations between treatment effects on the endpoints were evaluated using weighted linear regression between HRs for LFS and OS estimated within countries.
Results
The benefit of HDC/IL-2 over controls was statistically consistent across all subsets defined by baseline prognostic variables. I2 and P-values of X2 ranged from 0.00 to 0.51 and 0.14 to 0.91, respectively. Treatment effects were statistically significant in 14 of 28 subsets analyzed. The "leave-one-center-out" analysis confirmed that no single center dominated (P-values ranged from 0.004 to 0.020 [mean 0.009]). The HRs representing the HDC/IL-2 effects on LFS and OS were strongly correlated at the country level (R2 = 0.84).
Limitations
Small sample sizes in some of the subsets analyzed.
Conclusions
These analyses confirm the consistency and robustness of the HDC/IL-2 effect as compared with no treatment. LFS may be an acceptable surrogate for OS in future AML trials. Analyses of consistency and robustness may aid interpretation of data from multicenter trials, especially in populations with rare diseases, when the size of randomized clinical trials is limited.
Trial Registration
ClinicalTrials.gov: NCT00003991
