Ten years CHMG: Highlights Andreas Engert on behalf of the CHMG
Ten years CHMG: Highlights Cochrane Collaboration CHMG Highlights Summary
Cochrane Collaboration: Background International, independent non-profit organisation First Cochrane Center Oxford 1992 Cochrane Collaboration founded 1993 52 Cochrane Review Groups Generation, publication and dissemination of Cochrane Reviews Impact factor now 6.186!
Steering Group Cochrane Collaboration: Organisation Cochrane Centers Fields Consumer Network Cochrane Review Groups Methods Groups
Cochrane Review: a structured process Clinical relevant question Title registered with the Collaboration Protocol published Sensitive search strategy Trial identification (in duplicate) Data extraction (in duplicate) Data synthesis (with/without meta-analysis) According to PRISMA
Ten years CHMG: Highlights Cochrane Collaboration CHMG Highlights Summary
CHMG History 1999: Grant application Competence Network Malignant Lymphoma (KML) 2001: CHMG registered with the Cochrane Collaboration 2011: Comprehensive international and multidisciplinary network of clinicians, scientists and patient representatives
CHMG Scope Hodgkin and Non Hodgkin Lymphoma Acute and chronic leukemias Myelodysplastic Syndromes Multiple Myeloma Stem Cell Transplantation Aplastic Anaemia Haematopoietic Growth Factors Supportive Care in Hematology
CHMG Contributors 354 authors 15 editors 8 staff at the Editorial Base 1 consumer editor
CHMG authors from 30 countries
Protocols and Reviews by the CHMG
CHMG Co-operation (selection) German Cochrane Center German National Library of Medicine JNCI (Biannual reports) NICE, UK Agency for Healthcare Research and Quality, USA Institute for Quality and Efficiency in Health Care German Hodgkin Study Group German CLL Study Group EORTC
Projects Editorial Base (selection) Cochrane Reviews (BMBF) - Network Meta-Analyses (CLL, CML, G-CSF) - IPDs (ESAs, NHL, HL) - Prognostic factor project (CLL) - Cochrane Reviews Consumer Network (German Cancer Aid) Evidence-based S3 Guideline on HL (DKH)
CHMG: Selected papers G-CSF and GM-CSF in malignant lymphoma Bohlius et al, Br J Haematol 2003 Recombinant human erythropoietin in cancer patients Bohlius et al, JNCI 2005 Consort statement in reporting clinical trials in Hodgkins lymphoma Kober et al, JNCI 2006 Recombinant human erythropoietins and cancer patients Bohlius et al, JNCI 2006 High-dose chemotherapy in first-line aggressive NHL Greb et al, Cancer Treat Rev 2007 Rituximab and OS in indolent lymphoma Schulz et al, JNCI 2007 IPD on ESAs in cancer patients Bohlius et al, Lancet 2009
CHMG Funding Kompetenznetz Maligne Lymphome (KML) German Ministry of Education and Research (BMBF) German Cancer Aid German Research Foundation (DFG) University Hospital Cologne
Cochrane Collaboration: Funding
Ten years CHMG: Highlights Cochrane Collaboration CHMG Highlights Summary
Costs of new drugs in cancer medicine Garattini 2002
Anemia: Rationale for SRs on ESAs Anemia frequent among cancer patients Impacts organ function and QoL Negative prognostic factor in several malignancies Erythropoiesis-stimulating agents (ESAs) effective Total annual EPO sales >10 Billion US$ Safety concerns; impact on OS unclear
Thrombosis related to ESAs (35 studies) Bohlius et al, JNCI 2005
Literature-based SR on ESAs (OS) Period Studies Patients RR 95% CI 1985-2001 27 3.287 0.81 0.67-0.99 2002-2005 30 6.066 1.18 1.04-1.29 Bohlius et al, JNCI 2005, 2006
IPD on ESAs: Methods Analyses predefined in peer-reviewed, published protocol Analyses performed in two academic centers Steering Committee consisting of clinicians and methodologists Individual patient data contributed by companies (Amgen, J&J, Roche) and independent trialists Funded by German Federal Ministry of Education and Research (BMBF) and OncoSuisse
IPD on ESAs: Studies included n Pts All Chemotherapy Radiochemotherapy Radiotherapy None Others 53 38 5 3 4 2 13.933 10.441 737 799 1690 266 Bohlius et al, Lancet 2009
IPD on ESAs: Endpoints On study mortality - All cancer patients; chemotherapy only trials Overall survival - All cancer patients; chemotherapy only trials
IPD on ESAs: On study mortality* n HR P-value All cancer patients 13,933 1.17 (1.06 1.30) 0.002 Chemotherapy trials 10,441 1.10 (0.98 1.24) 0.12 There was no statistically significant heterogeneity among trials *Deaths during active study phase
IPD on ESAs: Summary ESA increased on-study mortality and worsened overall survival in cancer patients For patients undergoing chemotherapy, the increase was less pronounced, but could not be excluded The increased mortality must be balanced against the benefits of ESAs, taking into account each patient s clinical circumstances and preferences Bohlius, ASCO 2009
Impact in the Media
Ten years CHMG: Highlights Cochrane Collaboration CHMG Highlights Summary
Ten years CHMG: Summary CHMG successfully established Generates Systematic Reviews in hematology (>50 reviews&protocols) Published in Cochrane Library and other high-impact journals (Lancet, JNCI) Strategic national & international collaboration Developed HTA reports (NICE, AHRQ, IQWIG) and clinical guidelines (HL, ESAs, G-CSF ) EbM extremely relevant in decision-making
Co-ordinating Editor Andreas Engert Editorial Base Kathrin Bauer Ursula Georgi- Mikolajczyk Sabine Kluge Ina Monsef Michaela Rancea Bettina Schmidtke Nicole Skoetz Andrea Will www.chmg.de info@chmg.de Editoren Julia Bohlius, CH Michael Crump, CDN Benjamin Djulbegovic, USA Ambuj Kumar, USA Jörg J. Meerpohl, D Pia Raanani, IL Sue Richards, UK Guido Schwarzer, D Laurie Sehn, CDN Ofer Shpilberg, IL Lena Specht, DK Sven Trelle, CH Olaf Weingart, D Keith Wheatley, UK Consumer Editor Céline Fournier
Special thanks to: Thilo Kober Julia Bohlius Gail Higgins Olaf Weingart Michael Hallek Gerd Antes Editorial Base Team Editors and Reviewers Colleagues & Friends at Med I BMBF, German Cancer Aid, DFG Bettina Schmidtke Nicole Skoetz