Upfront autologous stem cell transplantation for untreated diffuse large B cell lymphoma patients in rituximab era: a sy
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ORIGINAL ARTICLE
Upfront autologous stem cell transplantation for untreated diffuse large B cell lymphoma patients in rituximab era: a systematic review and meta-analysis Shu-Yun Ma 1 & Xiao-Peng Tian 1 & Jun Cai 1 & Guang-Zheng Zhong 2 & Xu Chen 2 & Hui-Qiang Huang 1 & Tong-Yu Lin 1 & Zhi-Ming Li 1 & Qing-Qing Cai 1 Received: 29 October 2019 / Accepted: 28 March 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract To assess the survival outcomes and adverse events (AEs) of high-intermediate- or high-risk patients with diffuse large B cell lymphoma (DLBCL) who underwent conventional chemotherapy plus rituximab with or without first-line autologous stem cell transplantation (ASCT). Related studies published on Medline, Embase, Cochrane Library, and Web of science were searched, comprising both retrospective and randomized clinical trials (RCTs). The primary endpoints were overall survival (OS) and progression-free survival (PFS). The meta-analysis was performed using the software RevMan v5.3. Four RCTs and six retrospective trials with a total of 1811 patients were identified. Pooled data indicated that conventional chemotherapy plus rituximab followed by ASCT as the first-line therapy contributed to better PFS (HR = 0.73, 95% CI 0.62–0.86, p = 0.0002) but did not significantly improve OS (HR = 0.74, 95% CI 0.55–1.01, p = 0.06) of high-intermediate/high-risk patients. Subgroup analyses of patients with complete remission after induction chemotherapy may benefit from the upfront ASCT (OS, HR = 0.48, 95% CI 0.28–0.82, p = 0.008). The incidences of grade ≥ 3 hematological and non-hematological AEs occurred more frequently in the transplantation group. High-intermediate or high-risk untreated patients with DLBCL only achieved short-term survival benefit with the upfront ASCT. Keywords Diffuse large B cell lymphoma . ASCT . Rituximab . Conventional chemotherapy
Introduction Diffuse large B cell lymphoma (DLBCL) is the most common non-Hodgkin’s lymphoma with obvious Shu-Yun Ma, Xiao-Peng Tian and Jun Cai contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00277-020-04016-3) contains supplementary material, which is available to authorized users. * Qing-Qing Cai [email protected] 1
Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, People’s Republic of China
2
Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
aggressiveness and heterogeneity [1, 2]. It is potentially curable using rituximab-containing conventional chemotherapy, but the outcomes still remain unsatisfactory due to the high relapse rate in high-intermediate-risk or high-risk patients, classified using the International Prognostic Index (IPI) or age-adjusted IPI (aaIPI). Although the use of novel drugs such as monoclonal antibodi
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