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

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 В-cell lymphoma (DLBCL). About 40-50 % of patients, however, show refractoriness to this therapy or develop early relapses. Materials & Methods. A systematic review and meta-analysis were aimed at comparing the efficacy and safety of different first-line regimens in DLBCL treatment on the basis of data derived from the clinical studies published in 20142021. 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 pro-gression-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).