A systematic review and meta-analysis of immunochemotherapy with rituximab for B-cell non-Hodgkin's lymphoma

Abstract

Oncology, Huashan Hospital, Fudan University, Shanghai, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China Abstract Background. Although some randomized controlled trials had compared the anti-CD20 monoclonal antibody rituximab plus chemotherapy (R-chemo) to chemotherapy alone for B-cell non-Hodgkin's lymphoma, the curative effects of R-chemo were still controversial. A systematic review and meta-analysis was performed to examine the effi cacy of using R-chemo compared with the identical chemotherapy alone in the patients with B-cell non-Hodgkin's lymphoma. Material and methods. Medical databases and conference proceedings were searched for randomized controlled trials which compared R-chemo with chemotherapy alone in patients with newly diagnosed or relapsed B-cell non-Hodgkin's lymphoma. Endpoints were overall survival, overall response, disease control, and adverse events. Results. Twelve eligible trials were identifi ed, reporting outcomes of 4 996 patients. Fixed-effects analysis showed overall survival to be superior for R-chemo-treated patients (relative risks [RR], 1.09; 95%confi dence interval [CI], 1.06-1.12, p Ͻ0.00001). Superiority was also observed for the patients receiving R-chemo with respect to overall response (RR, 1.17; 95%CI, 1.10-1.25, p Ͻ0.00001), complete response (RR, 1.52; 95%CI, 1.27-1.82, p Ͻ0.00001), and disease control (RR, 1.36; 95%CI, 1.26-1.46, p Ͻ0.00001). R-chemo improved overall survival, overall response and disease control in patients with diffuse large B-cell lymphoma (RR, 1.11, 95%CI: 1.06-1.16, p Ͻ0.0001; RR, 1.09, 95%CI: 1.01-1.19, pϭ0.03 and RR, 2.00, 95%CI: 1.59-2.53, pϽ 0.00001, respectively) and follicular lymphoma (RR, 1.08, 95%CI: 1.04-1.12, p Ͻ0.0001; RR, 1.19, 95%CI: 1.07-1.33, p ϭ0.001 and RR, 2.58, 95%CI: 1.61-4.12, p Ͻ0.0001, respectively). Meanwhile, R-chemo improved overall response in patients with mantle cell lymphoma (RR, 1.22, 95%CI: 1.07-1.40, p ϭ0.004). Conclusion. R-chemo is superior to chemotherapy alone in patients with B-cell non-Hodgkin's lymphoma, especially for diffuse large B-cell lymphoma and follicular lymphoma.Non-Hodgkin's lymphoma is the most common hematologic cancer in adults, with the incidence of more than 66 000 cases anticipated in the United states in 2008 [1]. Approximately 85% of nonHodgkin's lymphomas in adults are of B-cell origin. Some B-cell non-Hodgkin's lymphomas are indolent, or slow growing, yet incurable. In contrast, others are aggressive or highly aggressive, and may be rapidly fatal, yet are often curable [2]. Diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL) and mantle cell lymphoma (MCL) are the main subtypes of B-cell lymphoma. Diffuse large B-cell lymphoma, with shorter overall survival and progression-free survival, is the most common subtype of aggressive B-cell lymphoma. Although patients with diffuse large B-cell lymphoma are potentially curable when treated with standard regimen: cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) and t...

Risk of infection in patients with lymphoma receiving rituximab: systematic review and meta-analysis

“…Finally, the results of meta-analysis on efficacy were consistent with other reviews focused on this issue [4,5] which have shown that R-C increases the response to therapy in patients with ML and that this effect is more evident in indolent than in aggressive lymphoma.…”

“…The evidence for no increased risk is strong and is supported by low risk of publication bias, negligible heterogeneity in the meta-analysis and is consistent with indications from other systematic reviews [4,5]. However, the results may suffer from potential bias due to sub-optimal quality of the studies.…”

“…R is a chimerical anti-CD20 monoclonal antibody (MoAb) with activity against normal and malignant B-cells expressing the cell-surface molecule CD20. Recent systematic reviews provide evidence that, in comparison to C alone, the combination of R and C (R-C) may increase the remission both in indolent [4] and aggressive CD20+ ML [5,6]. However, given the profound and prolonged immunosuppression produced by R, there are concerns that infections may arise [7].…”

Infections in patients taking Rituximab for hematologic malignancies: two-year cohort study

“…: HIV status, aggressive type of lymphoma, GVHD and low lymphocytes counts at nadir may increase the risk of infection during therapy with R. In addition the effect of these risk factors is significantly modified by time while in therapy. Since Rituximab has been shown to be safe and effective in clinical practice by at least 3 independent systematic reviews [3,4,25], we believe that prospective multicentre cohorts would be the best design to study the different effects of R containing protocols on risk of infections in different groups of patients. The definition of a set of clinically relevant risk factors and a better understating of their relation with time since therapy would greatly improve prevention and clinical management of infections.…”

Adäquate Supportivtherapie im therapeutischen Einsatz von „Biologicals“ bei gastrointestinalen(GI) Tumoren in der Onkochirurgie - Was muss der Chirurg wissen?

“…Dieser Transmembran-Antigen-CD20-Antikörper findet insbesondere bei niedrig-und hochmalignem B-Non-Hodgkin-Lymphom (NHL) Anwendung, weshalb auf die einschlägige hämato-logisch-onkologische Literatur in dieser Hinsicht verwiesen wird [19][20][21].…”