British journal of haematology
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Guidelines advise performing a computed tomography head scan for all anticoagulated head injured patients, but the risk of intracranial haemorrhage (ICH) after a minor head injury is unclear. We conducted a systematic review and meta-analysis to determine the incidence of ICH in anticoagulated patients presenting with a minor head injury and a Glasgow Coma Score (GCS) of 15. We followed Meta-Analyses and Systematic Reviews of Observational Studies guidelines. ⋯ The random effects pooled incidence of ICH was 8·9% (95% confidence interval 5·0-13·8%). In conclusion, around 9% of patients on vitamin K antagonists with a minor head injury develop ICH. There is little data on the risk of traumatic intracranial bleeding in patients who have a GSC 15 post-head injury and are prescribed a direct oral anticoagulant.
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Review Meta Analysis
Prognostic value of interim FDG-PET in Hodgkin lymphoma: systematic review and meta-analysis.
This study aimed to systematically review and meta-analyse the value of interim (18) F-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) in predicting treatment failure in Hodgkin lymphoma. MEDLINE was systematically searched for original studies that used standardized international criteria for interim FDG-PET interpretation. Included studies were methodologically assessed. ⋯ There was heterogeneity in DORs across individual studies (I2 = 72.7). The overall prognostic value of interim FDG-PET appears to be moderate for excluding and relatively high for identifying treatment failure in Hodgkin lymphoma. However, interim FDG-PET cannot yet be implemented in routine clinical practice due to moderate-quality evidence and inter-study heterogeneity that cannot be fully explained yet.
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Three-drug induction regimens have become the standard of care in newly diagnosed transplant-eligible multiple myeloma patients. Two frequently used protocols are bortezomib, cyclophosphamide and dexamethasone (VCD) and bortezomib, thalidomide and dexamethasone (VTD). Comparisons between the two are lacking. ⋯ Patients treated with VTD presented with a significantly higher complete/near complete response (34% vs. 6%, P = 0·002) as well as a higher very good partial response rate or better, following induction therapy (62% vs. 27%, P < 0·0001). Although grade 3-4 neurotoxicity was more frequent during VTD therapy (11% vs. 6%, P = 0·057), a higher incidence of overall grade 3-4 adverse events was found in the VCD-treated patients (74% vs. 51%, P < 0·001). VTD induction therapy may be superior in achieving deeper response rate following induction therapy, and is better tolerated.
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Meta Analysis Comparative Study
Comparison of modern and conventional imaging techniques in establishing multiple myeloma-related bone disease: a systematic review.
This systematic review of studies compared magnetic resonance imaging (MRI), (18) F-fluorodeoxyglucose positron emission tomography (FDG-PET), FDG-PET with computerized tomography (PET-CT) and CT with whole body X-Ray (WBXR) or (whole body) CT in order to provide evidence-based diagnostic guidelines in multiple myeloma bone disease. A comprehensive search of 3 bibliographic databases was performed; methodological quality was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria (score 1-14). Data from 32 directly comparative studies were extracted. ⋯ In our opinion, the equal performance of MRI also indicates that it is a valuable alternative. As lesions of the skull and ribs are underdiagnosed by modern imaging techniques we advise additional X-rays of these regions. The consequences of this approach are discussed.