Journal Appraisal on

Meta-Analysis
Joana Marie E. Gantuangco, MD
1st Year Fellow, Infectious Diseases
Philippine General Hospital
Case
• 23/M, single, with no known comorbidities
• 2-month history of exertional dyspnea, chest discomfort, and
facial swelling
• Consulted at a local hospital
Case
Chest CT:
10.5cm x 8.9cm x 8.2cm hypodense
inhomogenously enhancing lobulated
mass with necrotic areas in the right
anterior mediastinum encasing the right
brachiocephalic trunk with extension to
the retrosternal space, trachea, and
right main bronchus
Case
CT-guided biopsy:
Sheets of monomorphic small round cells composed of round to
ovoid, hyperchromatic nuclei with inconspicuous nucleoli and
ample cytoplasm.

CD45 Positive, CK Negative, SALL4 Negative

Consistent with Non-Hodgkin’s Lymphoma

Case
• Referred to PGH for possible chemotherapy
• Hema plans to start chemotherapy with R-CHOP
• Referred to IDS for clearance
Question
• Is it beneficial to give PCP prophylaxis in this patient?
Clinical Question
• Among patients with Non-Hodgkin’s Lymphoma on R-CHOP,
how effective is PCP antibiotic prophylaxis in preventing
pneumocystis pneumonia?
PEO
• P: Patients with Non-Hodgkin’s Lymphoma on R-CHOP
• E: PCP antibiotic prophylaxis
• O: Prevention of PCP
• M: Meta-analysis
Literature Search
1. Non-Hodgkin’s Lymphoma OR Lymphoma
2. Pneumocystis pneumonia
3. Prevention
4. Meta-analysis
Appraisal on Meta-Analysis
1. Appraising directness
2. Appraising validity
3. Appraising the results
4. Assessing applicability
5. Individualizing the results
 1. Appraising directness
Clinical Question Journal #1 (Jiang) Journal #2 (Huang)

Patients with Non-

Patients with NHL
P Hodgkin’s Lymphoma Patients with lymphoma
receiving R-CHOP21
on R-CHOP
PCP antibiotic
E PCP prophylaxis PCP prophylaxis
prophylaxis

O Prevention of PCP Prevention of PCP Prevention of PCP

M Meta-analysis (2015) Meta-analysis (2023)

2. Appraising validity
Question #1: Were the criteria for inclusion of studies appropriate?
2. Appraising validity
Question #1: Were the criteria for inclusion of studies appropriate?

Hashimoto
Hardak et al Kim et al Lee et al
et al

P NHL DLBCL NHL DLBCL

E TMP/SMX TMP/SMX Not given TMP/SMX

O PCP occurrence PCP occurrence PCP occurrence PCP occurrence

Retrospective Retrospective Retrospective Retrospective

M
cohort cohort cohort cohort
2. Appraising validity
Question #2: Was the search for eligible studies thorough?
 2. Appraising validity
Question #3: Was the validity of the included studies assessed?
Hashimoto et al Hardak et al Kim et al Lee et al
Randomly assigned? No No No No
Allocation concealed? No No No No
Similar baseline
Not stated Not stated Not stated No
characteristics?
Were patients blinded? No No No No
Were caregivers
No No No No
blinded?
Were outcome
No No No No
assessors blinded?
Were all patients
analyzed in the same No No No No
groups?

Adequate ff-up rate? Yes Yes Yes Yes

2. Appraising validity
Question #3: Was the validity of the included studies assessed?
2. Appraising validity
Question #4: Were the assessments of the studies reproducible?
3. Appraising the results
Question #1: What are the overall results of the review?
3. Appraising the results
Question #2: How precise were the results?
3. Appraising the results
Question #3: Were the results similar from study to study?
4. Assessing applicability
5. Individualizing the results