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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/11929

Title: Assessment of the consistency and robustness of results from a multicenter trial of remission maintenance therapy for acute myeloid leukemia
Authors: BUYSE, Marc
Squifflet, Pierre
Lucchesi, Kathryn J.
Brune, Mats L.
Castaigne, Sylvie
Rowe, Jacob M.
Issue Date: 2011
Citation: TRIALS, 12
Abstract: 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 (I-2) and interaction tests (X-2) 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. I-2 and P-values of X-2 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 (R-2 = 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.
Notes: [Buyse, Marc; Squifflet, Pierre] Int Inst Drug Dev, Dept Biostat, Louvain, Belgium. [Buyse, Marc] Hasselt Univ, Ctr Biostat, Diepenbeek, Belgium. [Lucchesi, Kathryn J.] Med Writing Dept, MedVal Sci Informat Serv, Skillman, NJ USA. [Brune, Mats L.] Univ Gothenburg, Sahlgrenska Acad, Hematol Unit, Gothenburg, Sweden. [Castaigne, Sylvie] Hop Andre Mignot, Serv Hematol & Oncol, Le Chesnay, France. [Rowe, Jacob M.] Technion Israel Inst Technol, Haifa, Israel. [Rowe, Jacob M.] Rambam Med Ctr, Dept Hematol & Bone Marrow Transplantat, Haifa, Israel. marc.buyse@iddi.com
URI: http://hdl.handle.net/1942/11929
DOI: 10.1186/1745-6215-12-86
ISI #: 000289515900001
ISSN: 1745-6215
Category: A1
Type: Journal Contribution
Validation: ecoom, 2012
Appears in Collections: Research publications

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