Treatment of Patients with Newly Diagnosed Diffuse Large B-Cell Lymphoma: A Systematic Review and Meta-Analysis

AUTOIMMUNE THROMBOCYTOPENIA

AS Luchinin

Kirov Research Institute of Hematology and Transfusiology, 72 Krasnoarmeiskaya ul., Kirov, Russian Federation, 610027

For correspondence: Aleksander Sergeevich Luchinin, MD, PhD, 72 Krasnoarmeiskaya ul., Kirov, Russian Federation, 610027; Tel.: +7(919)506-87-86; e-mail: glivec@mail.ru

For citation: Luchinin AS. Treatment of Patients with Newly Diagnosed Diffuse Large B-Cell Lymphoma: A Systematic Review and Meta-Analysis. Clinical oncohematology. 2022;15(2):130–9. (In Russ).

DOI: 10.21320/2500-2139-2022-15-2-130-139

ABSTRACT

Background. Up to now, R-CHOP-21 therapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) has been a standard option in the treatment of newly diagnosed diffuse large B-cell lymphoma (DLBCL). About 40–50 % of patients, however, show refractoriness to this therapy or develop early relapses.

Results. The outcomes of 22 clinical trials enrolling 9879 DLBCL patients were analyzed. The efficacies of different R-CHOP-21 therapy regimens were compared, and the progression-free-survivals were estimated. The network meta-analysis showed that, in the total cohort, the most effective first-line regimens were VenR-CHOP (hazard ratio [HR] 0.61; 95% confidence interval [95% CI] 0.37–1.00) and Pola-R-CHP (HR = 0.73; 95% CI 0.47–1.12). For non-GCB (ABC) subtype patients less than 60 years of age, R-ACVBP (HR = 0.31; 95% CI 0.12–0.79) and IR-CHOP (HR = 0.56; 95% CI 0.36–0.86) regimens appeared to be more effective than R-CHOP-21.

Conclusion. Today, the newly diagnosed DLBCL can be treated not only with R-CHOP-21, but also with alternative and more effective regimens. Their assignment, however, needs to be strictly personalized. IR-CHOP and R-ACVBP therapies can be administered in patients with non-GCB (ABC) subtype of DLBCL, if they are under 60 years of age. The list of these regimens can be further extended to include novel drugs, such as polatuzumab vedotin (its efficacy was confirmed by a randomized clinical trial) and venetoclax (its efficacy was confirmed by a non-randomized clinical trial).

Keywords: diffuse large B-cell lymphoma, meta-analysis.

Received: November 24, 2021

Accepted: March 7, 2022

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