Polatuzumab-Vedotin联合苯达莫司汀和利妥昔单抗治疗复发/难治性弥漫性大b细胞淋巴瘤的疗效和安全性：系统评价和荟萃分析

IF 5.5 2区医学 Q1 HEMATOLOGY

Critical reviews in oncology/hematology Pub Date : 2025-01-08 DOI:10.1016/j.critrevonc.2024.104611

Hanzala Ahmed Farooqi , Muhammad Saffi Ullah , Ahmed Raza , Zain Sadiq , Wardah Ali Shaikh , Rahmah Muhammad , Muhammad Shoaib Hussain

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引用次数: 0

摘要

背景：弥漫性大b细胞淋巴瘤（DLBCL）是最常见的非霍奇金淋巴瘤亚型，在初始治疗后40%的病例复发或变得难治性（R/R）。在这些患者的二线治疗中，CAR - t细胞治疗被认为是金标准，治疗效果优于SCT。对于这些患者，polatuzumab vedotin联合苯达莫司汀和利妥昔单抗（Pola-BR）是一种新的治疗方法。我们研究的主要目的是评估Pola-BR在R/R DLBCL患者中的疗效。方法：我们遵循PRISMA标准进行系统评价和荟萃分析。从一开始到2024年5月，使用Cochrane图书馆、PubMed和clinicaltrials.gov进行了搜索。研究包括随机对照试验、观察性研究和单臂研究，评估Pola-BR对R/R DLBCL患者的疗效。总缓解率（ORR）、部分缓解率（PR）和完全缓解率（CR）是主要预后指标。采用随机效应模型，在OpenMeta[Analyst]软件上进行统计分析，得出95%置信区间（ci）的合并风险比。结果：我们的研究纳入了8项研究，共398例患者。这些研究质量很高，合并分析显示ORR为52.6% (95% CI: 43.6 - 61.6%)， CR为34.3% (95% CI: 23.5 - 45.0%)， PR为15.5% （95% CI: 8.7 - 22.3%）。观察到明显的血液学毒性，最常见的是中性粒细胞减少症、血小板减少症、神经病变和贫血。结论：Pola-BR是晚期R/R DLBCL的有效选择，但具有明显的血液学毒性，需要谨慎管理。需要进一步的高质量随机试验来更好地了解和评估Pola-BR的成功。为了充分评估其有效性，必须将其与非细胞疗法进行比较。

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Efficacy and safety of polatuzumab-vedotin plus bendamustine and rituximab in patients with relapsed/refractory diffuse large B-cell lymphoma: A systematic review and meta-analysis

Background

Diffuse large B-cell lymphoma (DLBCL), the most common non-Hodgkin's lymphoma subtype, relapses or becomes refractory (R/R) in 40 % of cases after initial treatment. Among the second-line treatments for these patients is CAR T-cell therapy, which is considered the gold standard and treatment better than SCT. For these patients, polatuzumab vedotin in combination with bendamustine and rituximab (Pola-BR) is a novel treatment. The main goal of our research is to evaluate Pola-BR's efficacy in R/R DLBCL patients.

Methods

We followed PRISMA criteria for conducting this systematic review and meta-analysis. A search was conducted from the start until May 2024 using the Cochrane Library, PubMed, and clinicaltrials.gov. Studies included randomized-controlled trials, observational studies, and single-arm studies assessing Pola-BR efficacy in R/R DLBCL patients. The overall response rate (ORR), partial response (PR), and complete response (CR) were the main outcomes. Using random-effect models, statistical analysis was carried out on OpenMeta[Analyst] software leading to pooled risk ratios with 95 % confidence intervals (CIs).

Results

Eight studies with 398 patients were present in our study. The studies were of high quality, with pooled analysis showing a significant ORR of 52.6 % (95 % CI: 43.6 – 61.6 %), CR of 34.3 % (95 % CI: 23.5 – 45.0 %), and PR of 15.5 % (95 % CI: 8.7 – 22.3 %). Significant hematologic toxicities were observed, the most common being, neutropenia, thrombocytopenia, neuropathy, and anemia.

Conclusion

Pola-BR is an effective option for advanced R/R DLBCL but poses significant hematologic toxicity, requiring careful management. Further high-quality randomized trials are needed to better understand and evaluate Pola-BR's success. To fully assess its effectiveness, comparisons with non-cell therapies are essential.

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来源期刊

Critical reviews in oncology/hematology 医学-血液学

CiteScore

11.00

自引率

3.20%

发文量

213

审稿时长

55 days

期刊介绍： Critical Reviews in Oncology/Hematology publishes scholarly, critical reviews in all fields of oncology and hematology written by experts from around the world. Critical Reviews in Oncology/Hematology is the Official Journal of the European School of Oncology (ESO) and the International Society of Liquid Biopsy.