Rituximab maintenance therapy for patients with diffuse large B-cell lymphoma: A meta-analysis.
Rituximab maintenance therapy for patients with diffuse large B-cell lymphoma: A meta-analysis.
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弥漫性大 B 细胞淋巴瘤患者的利妥昔单抗维持治疗：荟萃分析
DOI：
10.1371/journal.pone.0174648
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Li J
中科院分区：
文献类型：
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作者：
Zhou X;Ma T;Zhang Y;Zhou N;Li J
目的：在标准化疗基础上加用利妥昔单抗能显著提高淋巴瘤患者的生存率。最近，利妥昔单抗维持治疗已被证明可以预防复发，并为滤泡或套细胞淋巴瘤患者提供生存益处。然而，利妥昔单抗在弥漫性大B细胞淋巴瘤（DLBCL）患者中的作用尚不清楚。在过去的一年中，进行了两项涉及利妥昔单抗治疗DLBCL的新研究。我们进行了一项Meta分析，以评估利妥昔单抗维持治疗DLBCL患者的效果。方法对PubMed、MEDLINE、EMBASE和科克伦对照试验中心数据库中2016年5月之前发表的相关随机对照试验进行综述。两名评审员独立评估了纳入研究的质量并提取了数据。汇总并估计至事件发生时间数据的风险比（HR）和其他数据的相对风险（RR）。结果共纳入5篇文献，共1740例患者。与观察组相比，接受利妥昔单抗维持治疗的患者的无事件生存期（EFS）（HR = 0.80，95%CI：0.65-0.98）和无进展生存期（PFS）（HR = 0.72，95%CI：0.54-0.94）显著改善。但是，两组的总生存期（OS）无统计学显著差异（HR = 0.66，95% CI：0.27-1.29）。一项亚组分析表明，男性患者可能从利妥昔单抗维持治疗中获益，EFS更好（HR = 0.53，95% CI：0.34-0.82-），而在女性患者中未观察到这种优势（HR = 0.99，95% CI：0.64-1.52）。结论：利妥昔单抗维持治疗可能提供超过一线和二线化疗的生存益处，尤其是在男性患者中。然而，利妥昔单抗维持治疗可能会导致更多的不良事件。建议在做出治疗决定时，应考虑生存获益和不良事件。
Purpose The addition of rituximab to standard chemotherapy has significantly improved survival in patients with lymphoma. Recently, maintenance therapy with rituximab has been shown to prevent relapse and provide survival benefits for patients with follicular or mantle cell lymphoma. However, the effects of rituximab in patients with diffuse large B-cell lymphoma (DLBCL) remain unclear. Two new studies involving rituximab in the treatment of DLBCL were performed this past year. We performed a meta analysis to evaluate the effects of rituximab maintenance treatment of patients with DLBCL. Methods Several databases (PubMed, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials) databases were reviewed for relevant randomized controlled trials published prior to May, 2016. Two reviewers assessed the quality of the included studies and extracted data independently. The hazard ratios (HRs) for time-to-event data and relative risks (RRs) for the other data were pooled and estimated. Results Totally 5 studies including 1740 patients were eligible for the meta-analysis. Compared to the observation group, patients who received rituximab maintenance therapy had significantly improved event-free survival (EFS) (HR = 0.80, 95% CI: 0.65–0.98) and progression-free survival (PFS) (HR = 0.72, 95% CI: 0.54–0.94). However, there was no statistically significant difference in overall survival (OS) (HR = 0.66, 95% CI: 0.27–1.29). A subgroup analysis suggested that male patients may benefit from rituximab maintenance therapy with a better EFS (HR = 0.53, 95% CI: 0.34–0.82-), while this advantage was not observed in female patients (HR = 0.99, 95% CI: 0.64–1.52). Conclusions Rituximab maintenance may provide survival benefits beyond that afforded by first- and second-line chemotherapy alone, especially in male patients. However, maintenance rituximab treatment may cause more adverse events. It is recommended that both survival benefits and adverse events should be taken into consideration when making treatment decisions.
DOI：
10.3760/cma.j.issn.0253-2727.2016.09.006
发表时间：
2016-09-14
影响因子：
--
作者：
Zhong HJ;Xu PP;Zhao WL
通讯作者：
Zhao WL