Abstract
BackgroundThe purpose of this network meta-analysis of randomized controlled trials (RCTs) was to compare rank targeted therapies for patients with diffuse large B-cell lymphoma (DLBCL).MethodsThe PubMed, EmBase, and Cochrane library electronic databases were systematically searched throughout December 2019. Direct and indirect evidence from relevant RCTs was identified for network meta-analysis. The pooled results for grade 3 or greater adverse events between targeted therapies and chemotherapy were calculated using a random-effects model.ResultsA total of 18 RCTs enrolling 8207 DLBCL patients were selected for the final meta-analysis. The results of the network analysis indicated that the addition of dacetuzumab (74.8%) to rituximab-based regimens or lenalidomide (77.1%) was associated with better therapeutic effects on overall survival, whereas dacetuzumab (80.4%) or bortezomib (70.8%) added to rituximab was most likely to improve events-free survival. Moreover, lenalidomide (93.8%) and I-tositumomab (77.2%) were associated with higher overall response rates. Finally, patients receiving targeted therapies were associated with an increased risk of diarrhea (RR: 2.63; 95%CI: 1.18–5.86; P = 0.019), and thrombocytopenia (RR: 1.41; 95%CI: 1.05–1.90; P = 0.023).ConclusionsThis study provides the best treatment strategy for DLBCL patients in terms of overall survival, events-free survival, and overall response rate. The findings of this study require validation with further large-scale RCTs.
Highlights
The purpose of this network meta-analysis of randomized controlled trials (RCTs) was to compare rank targeted therapies for patients with diffuse large B-cell lymphoma (DLBCL)
Studies were included if the following inclusion criteria were met: (1) Patients: all patients were diagnosed with DLBCL; (2) Intervention: rituximab, I-tositumomab, bevacizumab, bortezomib, dacetuzumab, ibrutinib, ofatumumab, obinutuzumab, or lenalidomide-based treatment regimens were used; (3) Control: chemotherapy or rituximab-based chemotherapy was used as a control; (4) Outcomes: the primary outcomes were overall survival (OS), events-free survival (EFS), and overall response rate (ORR), while the secondary outcomes included any potential adverse events; and (5) Study design: all included studies had to have a randomized controlled trial (RCT) design
18 RCTs assessing 8207 DLBCL patients were collected in our study [22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39] (Fig. 1)
Summary
The purpose of this network meta-analysis of randomized controlled trials (RCTs) was to compare rank targeted therapies for patients with diffuse large B-cell lymphoma (DLBCL). Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma in adults, accounting for nearly 30– 35% of malignancy in all newly diagnosed B-cell lymphomas. It is characteristically aggressive and potentially curable [1]. Diffuse large B-cell lymphoma is heterogeneous in morphology, genetics, and clinical behavior, and its outcomes can be predicted by several prognostic scores [2,3,4]. The prognoses for patients at intermediate to high risk according to the International Prognostic Index are improved by similar chemoimmunotherapy regimens, whereas the
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