Table 73Overall grade of strength of evidence for overall survival: CNS embryonal tumors

Key QuestionStudy DesignRisk of biasConsistencyDirectnessPrecisionStrength of AssociationOverall Grade/ Conclusion
For pediatric patients with CNS embryonal tumors, what is the comparative effectiveness and harms of tandem HSCT and single HSCT regarding overall survival?
Outcome of interest is overall survival.
The comparator is single HSCT.
There are three observational studies on tandem HSCT.
There are seven observational studies on single HSCT.
The risk of bias in this evidence is high.
There are differences in conditioning regimens and source of stem cell support across studies.
Results for overall survival are of unknown consistency.
Studies consist of multiple tumor types. There is variability in prognostic features between studies.
The outcomes reported are direct.
The comparisons are indirect as the evidence base utilizes two or more bodies of evidence to make comparisons.
The evidence is imprecise, effects are uncertain.
There is uncertainty on whether tandem HSCT is inferior, equivalent or superior to single HSCT.
Not applicable due to lack of obvious effect size.The body of evidence on tandem HSCT compared to single HSCT for the treatment of CNS embryonal tumors was insufficient to draw conclusions.
For pediatric patients with CNS embryonal tumors, what is the comparative effectiveness and harms of single HSCT and conventional therapy regarding overall survival?
Outcome of interest is overall survival.
The comparator is conventional therapy.
There are five observational studies on single HSCT.
There are two RCTs and one observational study on conventional therapy.
The risk of bias in this evidence is high.
One RCT was performed earlier in the mid-90s;
There are differences in treatment regimens and supportive care across studies.
Results are of unknown consistency.
Studies consist of multiple tumor types. There is variability in prognostic features between studies.
The outcomes reported are direct.
The comparisons are indirect as the evidence base utilizes two or more bodies of evidence to make comparisons.
The evidence is imprecise, effects are uncertain.
There is uncertainty on whether single HSCT is inferior, equivalent or superior to conventional chemotherapy.
Not applicable due to lack of obvious effect size.The body of evidence on single HSCT compared to conventional therapy for the treatment of CNS embryonal tumors was insufficient to draw conclusions.

From: Systematic Reviews

Cover of Hematopoietic Stem-Cell Transplantation in the Pediatric Population
Hematopoietic Stem-Cell Transplantation in the Pediatric Population [Internet].
Comparative Effectiveness Reviews, No. 48.
Ratko TA, Belinson SE, Brown HM, et al.

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