Article type
Abstract
Background. There is a need for guidance in assessing the certainty of evidence regarding prognostic factors (PFs), similar to therapeutic interventions or diagnostic tests. The GRADE approach has provided guidance on determining certainty in estimates of the association between PFs and future outcomes. Burkitt lymphoma (BL) in adults is a rare disease with a highly aggressive nature. Several studies have identified PFs associated with disease progression and mortality in adults with BL.
Objectives. To present our experience in implementing GRADE approach to assess the certainty of the evidence in a systematic review on PFs for survival in adults with BL.
Methods. We searched Medline, EMBASE, and CENTRAL for randomized or non-randomized clinical trials and longitudinal observational studies. Meta-analyses were conducted for overall survival (OS) and progression-free survival (PFS). The quality of studies was assessed using the Quality In Prognosis Studies (QUIPS) tool. An evaluation of inconsistency, indirectness, imprecision, and publication bias was performed. Evidence profiles were developed.
Results. Thirty-six studies (N=10882) were included. Twelve potential PFs for survival in BL adults were assessed. The available evidence suggests that advanced age, central nervous system and elevate performance status involvement reduces OS and PFS. Furthermore, OS is likely reduced for black patients. Higher albumin levels and bone marrow involvement reduce or likely reduce OS, respectively. Conversely, treatment with methotrexate increases OS and PFS and treatment with rituximab also improves OS. However, the evidence regarding rituximab’s prognostic effect on PFS is very uncertain. HIV status, sex, or risk stratification may result in little to no difference on survival.
Conclusions. Our experience highlights the utility of GRADE approach in assessing evidence on PFs. Despite the challenges posed by evaluating inconsistency, indirectness, imprecision, and publication bias, following GRADE guidelines ensures a rigorous and transparent assessment of the strength of inferences from bodies of evidence on PFs. This approach improves the quality and reliability of PF evaluations, thereby supporting better clinical decision-making and enhancing patient outcomes. This is particularly valuable in the context of rare diseases like Burkitt lymphoma, where evidence may be scarce and heterogeneous
Objectives. To present our experience in implementing GRADE approach to assess the certainty of the evidence in a systematic review on PFs for survival in adults with BL.
Methods. We searched Medline, EMBASE, and CENTRAL for randomized or non-randomized clinical trials and longitudinal observational studies. Meta-analyses were conducted for overall survival (OS) and progression-free survival (PFS). The quality of studies was assessed using the Quality In Prognosis Studies (QUIPS) tool. An evaluation of inconsistency, indirectness, imprecision, and publication bias was performed. Evidence profiles were developed.
Results. Thirty-six studies (N=10882) were included. Twelve potential PFs for survival in BL adults were assessed. The available evidence suggests that advanced age, central nervous system and elevate performance status involvement reduces OS and PFS. Furthermore, OS is likely reduced for black patients. Higher albumin levels and bone marrow involvement reduce or likely reduce OS, respectively. Conversely, treatment with methotrexate increases OS and PFS and treatment with rituximab also improves OS. However, the evidence regarding rituximab’s prognostic effect on PFS is very uncertain. HIV status, sex, or risk stratification may result in little to no difference on survival.
Conclusions. Our experience highlights the utility of GRADE approach in assessing evidence on PFs. Despite the challenges posed by evaluating inconsistency, indirectness, imprecision, and publication bias, following GRADE guidelines ensures a rigorous and transparent assessment of the strength of inferences from bodies of evidence on PFs. This approach improves the quality and reliability of PF evaluations, thereby supporting better clinical decision-making and enhancing patient outcomes. This is particularly valuable in the context of rare diseases like Burkitt lymphoma, where evidence may be scarce and heterogeneous