EFFICACY OF FRONT‐LINE IMMUNOCHEMOTHERAPY FOR TRANSPLANT‐INELIGIBLE MANTLE CELL LYMPHOMA: A NETWORK META‐ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Abstract

Background: In the past 20 years, there have been significant advances in the prognosis of mantle cell lymphoma (MCL) patients because of the introduction of rituximab. However, there is still no cure, and the relapse is inevitable. The earlier MCL patients progress after the first-line therapy, the worse the prognosis, especially for those who progress within 6 months after first-line therapy. There is no standard first-line immunochemotherapy regimen for transplant-ineligible patients with MCL currently, and the efficacy of various treatment remains unclear. Methods: Network meta-analysis (NMA) can compare the relative treatment effects of multiple interventions by synthesizing evidence from a network of randomized controlled trials (RCTs), which can be very useful for the choice of clinical treatment plans. We conducted a Bayesian NMA of all eligible randomized controlled trials. Pairwise comparisons and ranking of different first-line treatment options were performed. Results: nine studies were included in the NMA, involving a total of 2,897 MCL patients. The BR-Ibrutinib+R regimen showed the best progression-free survival (PFS), with a surface under the cumulative ranking curve (SUCRA) of 0.89 (Figure 1a) and probability of being the best treatment (PbBT) of 69%, followed by the BR+R regimen (SUCRA 0.76, PbBT 11%) and the BVR regimen (SUCRA 0.64, PbBT 13%). The VR-CAP regimen was the most potential intervention to improve overall survival (OS), with a SUCRA of 0.89 (Figure 1b) and PbBT of 63%, followed by the BR regimen (SUCRA 0.74, PbBT 22%) and the R-CHOP regimen (SUCRA 0.65, PbBT 1%). Compared with the R-CHOP regimen, the BR regimen achieved a better PFS (hazard ratio [HR] 0.45 [95% credible interval 0.2–0.96]). The BR-Ibrutinib+R regimen (HR 0.14 [0.02–0.99]), BR+R regimen (HR 0.19 [0.034–0.99]), and BR regimen (HR 0.19 [0.08–1.03]) were superior to CHOP regimen with better PFS. The R-FC regimen (HR 2.27 [1.01–5.21]) or FC regimen (HR 3.17 [1.15–8.71]) was inferior to the VR-CAP regimen with a worse OS. The research was funded by: This work was supported by Achievement Transformation Project (No. CGZH21001), 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (No. ZYJC21007), Translational Research Grant of NCRCH (No. 2021WWB03), Chengdu Science and Technology Program (No. 2022-YF05-01443-SN, 2022-YF05-01444-SN), Key Research and Development Program of Sichuan Province (No. 2023YFS0031, 2023YFS0306), National Natural Science Foundation of China (No. 82204490), and National Key Research and Development Program of China (No. 2022YFC2502600, 2022YFC2502603). Keywords: Aggressive B-cell non-Hodgkin lymphoma, Chemotherapy, Immunotherapy No conflicts of interests pertinent to the abstract.