紫杉醇-皮质类固醇融合治疗与小儿急性淋巴细胞白血病（ALL）维持治疗的关联受益不明确，特别是在现代强化治疗环境下。此次系统评价和meta分析评估了对新诊断的儿童B细胞ALL患者维持期间减少紫杉醇-皮质类固醇脉冲频次的影响。两位作者综合检索并评估风险，提取了25个包含12513名患者的出版物的数据。我们分为历史和现代亚组；后者包括早期柏林-法兰克福-明斯特试验提供的第III协议版本，并取消常规预防性颅脑放射治疗的试验。事件自由生存数据的meta分析表明，在现代试验中，频率更高或频率更低的脉冲没有区别（HR 0.96，95％CI 0.85-1.09），这与历史试验（HR 0.79，95％CI 0.68-0.91，p = 0.04 ）有显著差异。我们发现减少脉冲频率对总生存率或复发风险没有显著影响。然而，高脉冲频率组存在3+级非肝毒性增加的可能性（OR 1.31，95％CI 1.12-1.52）。此次系统评价表明，在现代试验中，维持治疗中频繁脉冲紫杉醇-皮质类固醇之前的受益在历史试验中不再适用，但与毒性相关。这些结果将有助于指导儿童ALL领域下一阶段的临床试验的开展，并质疑那些未在临床试验中的患者维持治疗中脉冲的继续使用，特别是那些经历毒性的患者。 Copyright © 2023美国血液病学会。

The benefit associated with the incorporation of vincristine-corticosteroid pulses into maintenance therapy for pediatric acute lymphoblastic leukemia (ALL) is unclear, particularly in the context of modern intensive therapy. This systematic review and meta-analysis examined the impact of reducing frequency of vincristine-steroid pulses during maintenance for newly diagnosed pediatric patients with B-cell ALL. Two authors reviewed all eligible studies identified through a comprehensive search, extracted data from the 25 included publications (12 513 patients), and assessed risk of bias. We created historical and contemporary subgroups; the latter included trials providing a version of Protocol III from early Berlin-Frankfurt-Munster trials and eliminating routine prophylactic cranial radiation. Meta-analysis of event-free survival data suggested no benefit between more frequent or less frequent pulses in contemporary trials (HR 0.96, 95%CI 0.85-1.09) which differs significantly from historical trials (HR 0.79, 95%CI 0.68-0.91, p=0.04). We found no significant impact of reduced pulse frequency on overall survival or relapse risk. There was however an increased odds of Grade 3+ non-hepatic toxicity in the high pulse frequency group (OR 1.31, 95%CI 1.12-1.52). This systematic review suggests that the previous benefit conferred by frequent pulses of vincristine-steroids in maintenance therapy for pediatric B-cell ALL in historical trials no longer applies in contemporary trials but is associated with toxicity. These results will help guide development of the next phase of clinical trials in the field of pediatric ALL and question the continued use of pulses in maintenance for patients not on clinical trials, particularly those experiencing toxicity.Copyright © 2023 American Society of Hematology.