Comparative efficacy of venetoclax-based regiments in the management of chronic lymphocytic leukemia: a systematic review and metanalysis.

Abstract

Chronic lymphocytic leukemia and small lymphocytic lymphoma (CLL/SLL) are common lymphoproliferative diseases in the elderly, accounting for 33% of all leukemias. The use of targeted therapies has significantly changed the management landscape of CLL/SLL. However, the efficacy of specific targeted therapies, such as venetoclax-based therapies, is limited. This review, therefore, aims to summarize the current evidence on the effectiveness and safety of venetoclax-based treatments in the management of CLL/SLL. We conducted a comprehensive search of three electronic databases, PubMed, Science Direct and Google Scholar, for all relevant articles. The reported outcomes were then analyzed using the statistical software Review Manager (RevMan 5.4.1). Our electronic search yielded 347 articles, of which only five were included in the review. We pooled the outcomes from 2195 patients. Our analysis found that venetoclax-based therapies significantly increased progression-free survival (PFS) (HR 0.30; 95% CI [0.21, 0.43] p < 0.00001), overall survival (OS) (HR 0.60; 95% CI [0.45, 0.80] p = 0.0004), and time to the next treatment (TTNT) (HR 0.29; 95% [0.18, 0.46] p < 0.00001). Additionally, we found the comparative safety of venetoclax-based therapies to other combination therapies. Our study found that venetoclax-based therapies are superior to other combination therapies in prolonging survival. Furthermore, they are comparable in safety to standard chemotherapy regimens and cost-effective. The findings of this review provide preliminary evidence on the efficacy of venetoclax-based regimens in CLL/SLL. However, further research is required to determine the best comparative regimen and the feasibility of venetoclax monotherapy in patients with CLL/SLL.