Abstract
Objective: Therapeutic results of relapsed/refractory mantle cell lymphoma (R/R MCL) are very disappointing at present, and there is no standard effective treatment regimen. Ibrutinib has been proved to be effective for R/R MCL, however, the sample size of these individual clinical studies was relatively small. Hence, current clinical experience in its usage is still limited. It is necessary to systematically analyze the efficacy and adverse reactions of ibrutinib in the treatment of R/R MCL. Methods: The PubMed, Cochrane Library, and Embase databases were searched using English search terms, mantle cell lymphoma, MCL, and ibrutinib; the VIP, Wanfang, and China National Knowledge Infrastructure (CNKI) databases were searched using the Chinese search terms, ibrutinib and mantle cell lymphoma. The extracted data were subjected to meta-analysis using R software to deduce the effective rate and occurrence rate of serious adverse reactions. Results: A total of 12 cohort studies were included in this analysis. The results demonstrated that ibrutinib could be an efficient therapy regimen for R/R MCL patients and the effect of combination therapy was better than that of single-drug therapy. During the treatment with ibrutinib, the adverse reactions mainly included hematological toxicity, infection, atrial fibrillation, and bleeding. Discussion: Our analysis showed ibrutinib is an optimal second-line treatment for R/R MCL, and the combination therapy is more effective than monotherapy as it was well-tolerated by the patients. Therefore, the combination of other drugs for R/R MCL should be considered for patients with poor efficacy of ibrutinib alone or relapse after treatment.
Highlights
Mantle cell lymphoma (MCL) is a malignant tumor derived from B lymphocytes
The combination of other drugs for refractory mantle cell lymphoma (R/R MCL) should be considered for patients with poor efficacy of ibrutinib alone or relapse after treatment
The results showed that the two-year PFS rate of ibrutinib in the treatment of R/R MCL patients was 41%, and the two-year PFS rate of combination therapy group was 59%, which was significantly higher than 37% of the monotherapy group 37%, indicating that the combination therapy could achieve a higher two-year PFS rate than the monotherapy (Figure 5). 4) Two-Year OS Rate The two-year OS rate of R/R MCL patients treated with ibrutinib was evaluated in 3 studies: 1 study of combination therapy with 27 patients, and 2 studies of monotherapy with 127 patients
Summary
Mantle cell lymphoma (MCL) is a malignant tumor derived from B lymphocytes. It is an invasive and refractory disease that progresses rapidly, and the long-term survival rate is low [1]. The genetic basis of MCL pathogenesis is the abnormality of chromosome t (11; 14) (q13; q32), which elevates the expression of Cyclin D1 and the cell cycle disorder [2]. Some patients with MCL responded to multi-drug combination chemotherapy, such as R-CHOP (rituximab, cyclophosphamide, Adriamycin, vincristine and prednisone) at the initial diagnosis, relapse was common, and the subsequent prognosis was poor. Study new drugs with low toxicity and improved efficacy
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