Therapeutic effects of chimeric antigen receptor T cells (CAR-T) on relapse/refractory diffuse large B-cell lymphoma (R/R DLBCL): a meta-analysis
Therapeutic effects of chimeric antigen receptor T cells (CAR-T) on relapse/refractory diffuse large B-cell lymphoma (R/R DLBCL): a meta-analysis
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DOI：
10.26355/eurrev_202005_21181
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发表时间：
2020-05-01
影响因子：
3.3
通讯作者：
Shen, Z-L
中科院分区：
文献类型：
--
作者：
Cao, H-H;Wang, L-L;Shen, Z-L
目的：弥漫性大B细胞淋巴瘤（DLBCL）是最常见的非霍奇金淋巴瘤（NHL）。本研究旨在系统评价嵌合抗原受体T细胞（CAR-T）治疗复发/难治性DLBCL（R/R DLBCL）的疗效及相关的完全缓解率（CR），材料与方法：检索PubMed、科克伦图书馆、中国知网、维普、中国生物医学文献数据库、万方数据库，并收集截至2019年1月的文献。根据纳入标准和排除标准，由两名研究者独立进行文献回顾和筛选，提取所需资料并交叉核对。结果：共纳入13篇英文文献，263例病例。所有这些研究之间均无异质性，因此采用固定效应模型。荟萃分析结果显示，CAR-T治疗R/R DLBCL的总CR率为46.8%（95% CI：0.408-0.533）。亚组分析显示，CD 28组的CR率[52.5%，95% CI：0.441-0.602]略高于4-1BB组[41.5%，95% CI：0.324-0.510]。CD 19组CR率（49.2%，95%CI：0.4290.556）略高于CD 20组（42.2%，95%CI：0.231-0.639）。总CR率、共刺激因子和靶抗原的漏斗图显示基本对称。此外，年龄、HSCT给药方式、CAR-T细胞计数、药物预处理也影响CAR-T免疫治疗R/R DLBCL的疗效。结论：CAR-T治疗R/R DLBCL疗效显著，完全缓解率高。CAR-T细胞免疫疗法有望成为血淋巴系统肿瘤的主流疗法。
OBJECTIVE: Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma (NHL). This study aimed to systematically evaluate the efficacy of chimeric antigen receptor T cells (CAR-T) in treating relapse/refractory DLBCL (R/R DLBCL) and associated complete-remission rate (CR).MATERIALS AND METHODS: PubMed, Cochrane Library, CNKI, VIP, CBM, and Wanfang databases were searched, and literature was collected up to January 2019. According to inclusion criteria and exclusion criteria, two researchers independently reviewed and screened literature, extracted required data and crossly checked them. This meta-analysis was conducted using RevMan 5.3 software.RESULTS: This study finally included 13 English literatures and 263 cases. There was no heterogeneity among all these studies, therefore, fixed effect model was used. Meta-analysis findings showed that total CR rate of R/R DLBCL treated with CAR-T was 46.8% (95% CI: 0.408-0.533). Subgroup analysis showed that CR rate of CD28 group was slightly higher [52.5%, with 95% confidence interval (CI): 0.441-0.602] compared to that of 4-1BB group (41.5%, with 95% CI: 0.324-0.510). CR rate of CD19 group was slightly higher (49.2%, with 95% CI: 0.4290.556) compared to that of CD20 group (42.2%, with 95% CI: 0.231-0.639). Funnel chart of total CR rate, co-stimulatory factor, and target antigen demonstrated fundamental symmetry. Moreover, age, HSCT administration, CAR-T cell counts, and drug pre-treatment also affected immunotherapy on CAR-T on R/R DLBCL.CONCLUSIONS: CAR-T treatment for R/R DLBCL demonstrated evident curative effect and high complete remission rate. CAR-T cell immunotherapy would be expected to become mainstream therapy for hematolymph system tumors.