Nueclear Web Banner
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 12  |  Issue : 5  |  Page : 11-14

Aidi injection combined with CHOP chemotherapy regimen in the treatment of malignant lymphoma: A meta-analysis based on randomized controlled trials


Department of Hematology, The People's Hospital of Liushui (The 6thAffiliated Hospital of Wenzhou Medican University), Lishui 323000, Zhejiang Province, China

Date of Web Publication7-Oct-2016

Correspondence Address:
Xiaoqiu Wang
Department of Hematology, The People's Hospital of Liushui (The 6th Affiliated Hospital of Wenzhou Medican University), Lishui 323000, Zhejiang Province
China
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.191619

Rights and Permissions
 > Abstract 


Objective: The aim of this study was to evaluate the clinical efficacy of Aidi injection combined with CHOP chemotherapy regimen in the treatment of malignant lymphoma.
Methods: We made an electronic search in the database of Wanfang, CNKI, and PubMed. All the clinical studies related to Aidi injection combined with CHOP chemotherapy regimen in the treatment of malignant lymphoma were screened and reviewed. The combined objective response rate (ORR), life quality improvement, and hematological toxicity were pooled by random- or fixed-effect model according to the heterogeneity across the included study. Moreover, the publication bias was evaluated by Begg's funnel plot and Egger's line regression test.
Results: Eight prospective clinical trials with 513 subjects (273 in the Aidi injection plus CHOP group and 240 in the CHOP group) were included in this meta-analysis. The pooled results showed that Aidi injection combined with CHOP chemotherapy regimen can significantly improve the ORR (odds ratio [OR] =1.68, 95% confidence interval [CI]: 1.09–2.60, P < 0.05), improve the life quality (OR = 3.32, 95% CI: 1.97–5.58, P < 0.05), and decrease the risk of developing leukopenia (OR = 0.25, 95% CI: 0.17–0.39, P < 0.05) and thrombocytopenia (OR = 0.34, 95% CI: 0.22–0.53, P < 0.05).
Conclusion: With the present evidence, Aidi injection combined with CHOP chemotherapy regimen can improve the treatment response and quality of life and decrease the risk of developing severe leukopenia or thrombocytopenia.

Keywords: Aidi injection, CHOP chemotherapy regimen, malignant lymphoma, meta-analysis


How to cite this article:
Wang X, Jin W, Fang B, Jiang J, Liu M, Lan Y, Qu Z, Ma G, Jiang Y, Liu Y, Zeng Y, Wang X. Aidi injection combined with CHOP chemotherapy regimen in the treatment of malignant lymphoma: A meta-analysis based on randomized controlled trials. J Can Res Ther 2016;12:11-4

How to cite this URL:
Wang X, Jin W, Fang B, Jiang J, Liu M, Lan Y, Qu Z, Ma G, Jiang Y, Liu Y, Zeng Y, Wang X. Aidi injection combined with CHOP chemotherapy regimen in the treatment of malignant lymphoma: A meta-analysis based on randomized controlled trials. J Can Res Ther [serial online] 2016 [cited 2018 May 22];12:11-4. Available from: http://www.cancerjournal.net/text.asp?2016/12/5/11/191619




 > Introduction Top


Lymphoma is a group of blood cell tumors that develop from lymphatic cells.[1] According to pathology, it was generally divided into non-Hodgkin lymphoma and Hodgkin lymphoma.[2] Epidemiology study showed that about 90% of lymphomas are non-Hodgkin lymphomas, which was more invasive than Hodgkin lymphoma.[3] The general treatment strategy for malignant lymphoma was chemotherapy. The CHOP chemotherapy regimen was widespread use for lymphoma with relative acceptable response rate. Recently, several studies reported that Aidi injection combined with CHOP chemotherapy regimen could improve the prognosis of patients with malignant lymphoma.[4],[5] However, the patients' number included in each study was small with limited statistical power. Hence, we performed this meta-analysis to further evaluate the clinical efficacy of Aidi injection combined with CHOP chemotherapy regimen in the treatment of malignant lymphoma.


 > Methods Top


Search strategy

We made an electronic search in the database of Wanfang, CNKI, and PubMed. All the clinical studies related to Aidi injection combined with CHOP chemotherapy regimen in the treatment of malignant lymphoma were screened and reviewed. The following search words were used: “Aidi/Aidi injection,” “lymphoma,” “non-Hodgkin lymphoma,” “Hodgkin lymphoma.” Searches were limited to human trials, with the language restriction of English and Chinese. All references of relevant articles were reviewed for additional analysis.

Selection criteria

The selection criteria were made according to the patient, intervention, control, outcome strategy. Patients were limited to malignant lymphoma including non-Hodgkin lymphoma and Hodgkin lymphoma. All the patients were confirmed by cytology or pathology; the intervention is limited to Aidi injection combined with CHOP chemotherapy regimen for the treatment of malignant lymphoma; patients in the control group were treated with CHOP chemotherapy regimen only; moreover, for the outcome, the original study should provide the objective response rate (ORR).

Data extraction

Bao Liyan and Zhao Peng independently extracted the data from the included original studies according Cochran Handbook. Moreover, the data were cross-checked after extraction. If the disagreement was encountered, the third reviewer was consulted to make a decision. The general information (such as name of the authors, country the trial was made, year of publication) and the outcome data (such as objective response rate, life quality improvement, and hematological toxicity) were carefully extracted from the included original studies.

Statistical analysis

STATA 11.0 (http://www.stata.com; Stata Corporation, College Station, TX, USA) was used to deal with the statistical analysis. Statistical heterogeneity among the included studies was tested by Chi-square test,[6] and the inconsistency was calculated by I2.[7] If heterogeneity was found (χ2, P</i> 0.05 or I2 > 50%), the random-effect method (DerSimonian–Laird method) was used to pool the data. Otherwise, without significant heterogeneity, fixed-effect method was used. The Begg's funnel plot and Egger's line regression tests were used for each effect size to evaluate possible publication bias as described by Egger.[8]

Characteristics of the included studies

Finally, a total of eight studies with 513 subjects (273 in the Aidi injection plus CHOP group and 240 in the CHOP group) were included in this meta-analysis. The articles were published from 2003 to 2012, with the age range of 7–76. Patients in all of the included eight studies were Chinese. Six studies reported the treatment course of 21 days and one with 14 days and one with 28 days. The general characteristics of included eight studies are demonstrated in [Table 1].
Table 1: General characteristics of included studies

Click here to view


Objective response

Six studies reported the ORR. Heterogeneity was assessed by I2, and no significant heterogeneity existed among the six studies. The pooled ORR was pooled by fixed-effect model. The pooled data indicated that Aidi injection combined with CHOP chemotherapy regimen can significant improve the ORR for patients with malignant lymphoma compared to CHOP chemotherapy regimen only (odds ratio [OR] = 1.68, 95% confidence interval [CI]: 1.09–2.60, P < 0.05) [Figure 1]. The publication bias was evaluated by Begg's funnel plot. The Begg's funnel plot was symmetric which indicated no publication bias [Figure 2].
Figure 1: Forest plot for evaluation the objective response rate

Click here to view
Figure 2: Funnel plot for evaluation publication bias for objective response rate

Click here to view


Life quality improvement

Five studies reported the quality improvement without significant heterogeneity across the included studies. The data were pooled by fixed-effect model which showed that significant improvement was found in patients treated with Aidi injection combined with CHOP chemotherapy regimen (OR = 3.32, 95% CI: 1.97–5.58, P < 0.05) [Figure 3]. However, Egger's line regression test (t = 4.01, P = 0.028) and Begg's funnel plot showed significant publication bias for life quality improvement [Figure 4].
Figure 3: Forest plot for evaluation the life quality improvement

Click here to view
Figure 4: Funnel plot for evaluation publication bias for life quality improvement

Click here to view


Hematological toxicity

Eight studies reported the leukopenia and six studies reported the thrombocytopenia. No significant heterogeneity was found for leukopenia and thrombocytopenia data pooling. Hence, the data were pooled by fixed-effect model. The combined data showed that then combination of Aidi injection and CHOP chemotherapy regimen can significantly decrease the risk of developing leukopenia (OR = 0.25, 95% CI: 0.17–0.39, P < 0.05) and thrombocytopenia (OR = 0.34, 95% CI: 0.22–0.53, P < 0.05) [Figure 5]. The Begg's funnel plot showed asymmetric, but the Egger's line regression test demonstrated no publication bias (t = −1.90, P = 0.083) [Figure 6].
Figure 5: Forest plot for evaluation hematological toxicity

Click here to view
Figure 6: Funnel plot for evaluation publication bias for hematological toxicity

Click here to view



 > Discussion Top


Lymphoma is one of the most diagnosed malignant tumors arise from lymphatic hematopoietic system.[8] In China, malignant lymphoma was one of the ten highest morbidity carcinomas with the incidence rate of 88.2/100,000 and mortality rate of 52.1/100,000 according to the recent study.[14] Hence, malignant lymphoma is one of the leading causes of cancer-related death for Chinese patients.

The general treatment for malignant lymphoma is chemotherapy. The one of the most used chemotherapy regimens was CHOP which consists of: cyclophosphamide (C), an alkylating agent which damages DNA by binding to it and causing the formation of cross-links; hydroxydaunorubicin (H, also called doxorubicin or adriamycin), an intercalating agent which damages DNA by inserting itself between DNA bases; oncovin (O, vincristine), which prevents cells from duplicating by binding to the protein tubulin; and prednisone (P) or prednisolone (P), which are corticosteroids. Recently, several studies reported that Aidi injection combined with CHOP chemotherapy regimen could improve the prognosis of patients with malignant lymphoma.[10],[11] Aidi injection made by extraction of Ren Shen (Radix Ginseng), Huang Qi (Radix Astragali), Ci Wu Jia (Radix Acantropanacis Senticosi), and Ban Mao (Mylabri) is often used for clinical treatment of cancer. Several studies [15],[16] have demonstrated that Aidi injection can inhibit growth of tumor cells, induce apoptosis, reverse multidrug resistance, decrease the side effect of radiotherapy or chemotherapy, increase immune function, and improve life quality of the patient. Several studies have reported the clinical efficacy of Aidi injection for adjuvant treatment of malignant lymphoma. However, the patients' number included in each study was small with limited statistical power. To further explicate the effects of Aidi injection for adjuvant treatment of malignant lymphoma, we performed this meta-analysis. In this study, we included eight open-published articles reporting the clinical efficacy of Aidi injection combined with CHOP chemotherapy regimen in the treatment of malignant lymphoma. The pooled date indicated that Aidi injection combined with CHOP chemotherapy regimen can significantly improve the ORR (P < 0.05), improve the life quality (P < 0.05), and decrease the risk of developing leukopenia (P < 0.05) and thrombocytopenia (P < 0.05).

However, there are several limitations for this meta-analysis. (1) Only eight studies were included in this meta-analysis with small number cases for each original paper; (2) all the included studies are published in Chinese which would result in selection bias; (3) the treatment course was not consistent with each other, which would lead to clinical heterogeneity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 > References Top

1.
Han van Krieken J. New developments in the pathology of malignant lymphoma: A review of the literature published from May 2015-September 2015. J Hematop 2015;8:225-34.  Back to cited text no. 1
[PUBMED]    
2.
Herrinton LJ. Epidemiology of the revised European-American lymphoma classification subtypes. Epidemiol Rev 1998;20:187-203.  Back to cited text no. 2
[PUBMED]    
3.
van Krieken JH. New developments in the pathology of malignant lymphoma. A review of the literature published from September 2015-December 2015. J Hematop 2016;9:19-27.  Back to cited text no. 3
[PUBMED]    
4.
Dingxin L. Addie injection combined with chemotherapy for non-Hodgkin's lymphoma and detoxicating effect. Jiangxi J Tradit Chin Med 2003;22:18.  Back to cited text no. 4
    
5.
Wu Guangxing YZ, Enbi C. Chemotherapy plus Aidi injection in the treatment of malignant lymphoma. J Chin Physician 2005;7:1425-6.  Back to cited text no. 5
    
6.
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177-88.  Back to cited text no. 6
[PUBMED]    
7.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557-60.  Back to cited text no. 7
[PUBMED]    
8.
Zappasodi R, de Braud F, Di Nicola M. Lymphoma immunotherapy: Current status. Front Immunol 2015;6:448.  Back to cited text no. 8
[PUBMED]    
9.
Ying W. A clinical observation of Aidi injection combined with cyclophosphamide, vincristine, doxorubicin, and prednisone in treatment of non-Hodgkin's lymphoma. Clin Focus 2007;22:426-7.  Back to cited text no. 9
    
10.
Diao Lianjun WX, Zhang L. Aidi injection combined with CHOP regimen in the treatment non-Hodgkin lymphoma: A clinical trial. J Leuk Lymphoma 2010;19:53-4.  Back to cited text no. 10
    
11.
Liansheng P. The clinical efficacy of Aidi injection combine with CHOP in the treatment of non-Hodgkin lymphoma. Shandong Med 2012;10:629.  Back to cited text no. 11
    
12.
Xiaogang Y. The effect of Addie injection combined with chemotherapy on immune function in patients with malignant lymphoma. China J Chin Med 2012;27:789-90.  Back to cited text no. 12
    
13.
Yang Xiaogang HY, Zengmei S. Clinical study of Addie injection combined with CHOP regimen in the treatment of non-Hodgkin lymphoma. China J Chin Med 2014;7:951-3.  Back to cited text no. 13
    
14.
Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, et al. Cancer statistics in China, 2015. CA Cancer J Clin 2016;66:115-32.  Back to cited text no. 14
[PUBMED]    
15.
Tang L, Zeng FB, Wang T, Wu M. Effects of Aidi on hepatocellular carcinoma cells apoptosis. China Pharm 2006;9:198-200.  Back to cited text no. 15
    
16.
Zhang H, Jiang H, Hu X, Jia Z. Aidi injection combined with radiation in the treatment of non-small cell lung cancer: A meta-analysis evaluation the efficacy and side effects. J Cancer Res Ther 2015;11 Suppl 1:C118-21.  Back to cited text no. 16
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  >Abstract>Introduction>Methods>Discussion>Article Figures>Article Tables
  In this article
>References

 Article Access Statistics
    Viewed878    
    Printed12    
    Emailed0    
    PDF Downloaded105    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]