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!

Cochrane Collaboration: Organisation

Cochrane

Centers

Methods

Groups

Fields

Consumer

Network

Cochrane

Review

Groups

Ste

eri

ng

Gro

up

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)

• 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: Selected papers

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

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

Literature-based SR on ESAs (OS)

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

799 3 Radiotherapy

13.933 53 All

737 5 Radiochemotherapy

266 2 Others

1690 4 None

10.441 38 Chemotherapy

Pts n

Bohlius et al, Lancet 2009

• On study mortality

- All cancer patients; chemotherapy only trials

• Overall survival

- All cancer patients; chemotherapy only trials

IPD on ESAs: Endpoints

IPD on ESAs: On study mortality*

There was no statistically significant heterogeneity among trials

*Deaths during active study phase

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

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

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

www.chmg.de

info@chmg.de

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