Pediatric-inspired regimens and HSCT for adolescents and young adults with acute lymphoblastic leukemia.

To support a clinical practice guideline, we systematically reviewed and meta-analyzed evidence on (1) asparaginase-based (pediatric) vs non-asparaginase-based (adult) regimens and (2) allogeneic hematopoietic stem cell transplantation (HSCT) vs no HSCT for AYAs (aged 15-39 years) with ALL in first complete remission.

为了支持临床实践指南，我们系统地回顾和荟萃分析了关于（1）以天冬酰胺酶为基础的（儿科）与非天冬酰胺酶为基础的（成人）方案以及（2）异基因造血干细胞移植（HSCT）与无HSCT对于15-39岁处于首次完全缓解期的AYAs ALL患者的证据。

Data sources were PubMed, CINAHL, and PsycINFO from inception to 29 November 2023.

数据来源包括自建库起至2023年11月29日的PubMed、CINAHL和PsycINFO数据库。

Eligible studies compared regimens or the use of HSCT and reported survival, remission, toxicity, or quality of life in AYAs.

符合条件的研究比较了治疗方案或造血干细胞移植（HSCT）的使用，并报告了青少年和年轻成人的生存率、缓解率、毒性和生活质量。

We included 19 studies (14 comparative, 5 single-group; N = 3607) comparing regimens and 7 studies (N = 7492) comparing HSCT and no HSCT.

我们纳入了19项研究（14项比较性研究，5项单组研究；N=3607），比较了不同治疗方案，并纳入了7项研究（N=7492），比较了造血干细胞移植（HSCT）与非HSCT治疗。

Studies were mostly of poor quality, with sparse randomized controlled trials (RCTs), yielding low-certainty findings.

这些研究质量普遍较差，随机对照试验（RCTs）较少，得出的结论确定性较低。

Pediatric regimens were associated with higher 5-year overall survival(OS; relative risk [RR], 1.40; 95% confidence interval[CI], 1.18-1.65), event-free survival (RR, 1.80; 95% CI, 1.13-2.85), disease-free survival (DFS; RR, 1.55; 95% CI, 1.32-1.82), and lower treatment-related mortality (TRM; RR, 0.29; 95% CI, 0.09-0.90).

儿科方案与更高的5年总生存率（OS; 相对风险[RR], 1.40; 95% 置信区间[CI], 1.18-1.65）、无事件生存率（RR, 1.80; 95% CI, 1.13-2.85）、无病生存率（DFS; RR, 1.55; 95% CI, 1.32-1.82）以及更低的治疗相关死亡率（TRM; RR, 0.29; 95% CI, 0.09-0.90）相关。

HSCT was associated with lower 5-year OS (RR, 0.72; 95% CI, 0.61-0.84) and DFS (RR, 0.78; 95% CI, 0.68-0.90) and higher nonrelapse mortality (RR, 2.70; 95% CI, 1.18-6.18) and TRM (hazard ratio, 6.88; 95% CI, 3.02-15.70).

造血干细胞移植（HSCT）与更低的5年总生存率（RR, 0.72; 95% CI, 0.61-0.84）和无病生存率（RR, 0.78; 95% CI, 0.68-0.90）以及更高的非复发死亡率（RR, 2.70; 95% CI, 1.18-6.18）和治疗相关死亡率（风险比, 6.88; 95% CI, 3.02-15.70）相关。

Relapse risk varied by time point.

复发风险随时间点的不同而变化。

In AYAs with Philadelphia chromosome-negative ALL, pediatric regimens may improve survival; toxicity-related evidence remains limited.

在携带费城染色体阴性的青少年和年轻成人急性淋巴细胞白血病患者中，儿科方案可能改善生存率；关于毒性的证据仍然有限。

HSCT may lead to inferior OS and DFS.

造血干细胞移植可能导致总生存期和无病生存期较差。

With a dearth of RCTs, low-certainty evidence highlights the need for high-quality studies and subanalyses of AYAs.

由于随机对照试验的缺乏，证据的确定性较低，突显了高质量研究和青少年及年轻成人亚组分析的需求。