Follow-up of patients receiving rituximab for diffuse large B cell lymphoma: an overview of systematic reviews

Abstract

The advent of rituximab has significantly improved the clinical outcomes of patients with diffuse large B cell lymphoma (DLBCL). Although rituximab is considered safe and effective, data on its long-term use are limited, which suggests that patients should undergo systematic, long-term follow-up aiming to identify delayed or yet undescribed adverse reactions and optimize treatment effectiveness. This study presents an overview of systematic reviews of strategies for follow-up of DLBCL patients receiving rituximab and documents the current state of knowledge on efficacy and safety in this population. A highly sensitive strategy was used to identify systematic reviews of randomized clinical trials (RCTs) in the Cochrane Library, Embase, Lilacs, MEDLINE, and Scirus databases. A handsearch of medical and government agency websites was also conducted. Seven studies were included, among them there were RCTs of patients who used CHOP/CHOP-like chemotherapy plus rituximab for three to eight cycles every 14 to 21 days as induction therapy, whereas some studies used maintenance therapy for 3 to 24 months. Only one study described a follow-up model for management of adverse drug reactions. The benefits of rituximab for induction therapy of DLBCL were demonstrated, although there is no evidence of significant improvement in the overall survival of high-risk patients or those with HIV-related lymphoma. Rituximab therapy was associated with increased rates of fever, infection, and grade 3/4 hematological toxicity, as well as higher infection-related mortality in HIV-positive patients. Although one study addressed the management of adverse reactions to rituximab, our search did not yield any publications on systematic follow-up strategies for these patients. This finding suggests that such instruments should be developed and validated to optimize the effectiveness and long-term safety of novel therapies.

Tendência de mortalidade por linfomas não Hodgkin no Brasil, 1980 a 2012

“…Outro fator importante a ser destacado foi o aumento no padrão de sobrevida para pacientes com LNH, ocorrida inicialmente em países desenvolvidos em fins da década de 1990 21,22 . Essa mudança também começou a ser notada em países em desenvolvimento, como o Brasil, com a introdução de novas drogas que vêm contribuindo na redução da mortalidade por LNH 9,23 . Esses possíveis padrões de redução e de estabilidade das taxas de mortalidade observados em alguns Estados e regiões podem ser atribuídos a essa melhoria do tratamento e do acesso aos serviços de saúde.…”

Rituximab maintenance therapy for patients with diffuse large B-cell lymphoma: A meta-analysis

“…The main adverse events were granulocytopenia and infection. It was recommended to delay the next cycle or discontinue the treatment if such an event occurred[20]. However, we did not find any publications referring to the management of these events.…”

“…However, we did not find any publications referring to the management of these events. There was a review article[20] focused on the follow-up of DLBCL patients receiving rituximab. And no significant differences were seen in terms of treatment-related death between groups.…”

Rituximab Treatment Strategy for Patients with Diffuse Large B-Cell Lymphoma after First-Line Therapy

“…The value of rituximab as maintenance or salvage therapy for DLBCL patients who respond to induction therapy or suffer relapse is yet to be determined. [ 11 ] We performed a systematic review of the literature and a meta-analysis of all randomized trials to evaluate the effects of rituximab maintenance treatment and salvage therapy for patients with DLBCL.…”