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Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma in adults, accounting for 35% of all non-Hodgkin’s lymphomas (NHL)
.
The use of rituximab improves the efficacy and overall survival of DLBCL patients
.
The current standard treatment R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) can cure nearly two-thirds of DLBCL patients
.
So far, attempts at various treatment options including adding new drugs have failed to further improve the prognosis of DLBCL patients
.
Radiotherapy is also an effective treatment for lymphoma, but its role in consolidation therapy in patients with advanced DLBCL after immunochemotherapy is currently uncertain
.
Based on this, some researchers have carried out a meta-analysis to evaluate the value of radiotherapy as a consolidation therapy for patients with advanced DLBCL after immunochemotherapy
.
01 Research methods Researchers used a comprehensive meta-analysis and systematic search of abstracts published in Pubmed, Embase, Cochrane, ASCO, ASH, ESMO, and ASTRO from June 1966 to December 2018 to evaluate radiotherapy in patients with advanced DLBCL immunochemotherapy Consolidate the effect of treatment
.
The researchers identified 11 clinical trials evaluating DLBCL immunochemotherapy and consolidation radiotherapy, of which 4584 patients were from randomized clinical studies
.
The primary endpoint of this meta-analysis is the patient's progression-free survival (PFS)
.
02 Results of the study The meta-analysis included 4584 patients recruited between 1983 and 2013
.
After screening, the data of a total of 2488 patients can be analyzed for PFS.
In the summary bivariate meta-analysis, the summary HR was 0.
77 (95% CI: 0.
51-1.
17) and 0.
80 (95% CI: 0.
53-1.
21) (Figure 1)
.
For the overall survival (OS) analysis, a total of 2744 patients were included.
In the bivariate meta-analysis, the pooled HR was 0.
93 (95% CI: 0.
61-1.
40) and 0.
86 (95% CI: 0.
58-1.
27) (Figure 2)
.
The heterogeneity between the two results is high
.
However, with the passage of time, the lack of benefit of consolidation radiotherapy after immunochemotherapy remains stable, and time alone cannot explain the heterogeneity observed in the meta-analysis
.
Figure 1 The effect of consolidation radiotherapy on PFS Figure 2 The effect of consolidation radiotherapy on OS In view of the significant heterogeneity, the researchers further used stratification to analyze the data: (1) Whether the chemotherapy regimens used by the two groups of patients are similar, (2 ) The use of rituximab in the two groups of patients, (3) the specific dose of radiotherapy, and (4) whether the radiotherapy was performed only after complete morphological remission
.
In addition, the researchers also stratified according to the characteristics of the trial population: (5) the average age of the patients receiving treatment, (6) whether the majority of patients are at an advanced stage, and (7) whether most patients are accompanied by large masses
.
The results of the stratified analysis showed that the heterogeneity between clinical trials could not be explained by stratified analysis of any of these subgroups
.
In addition, none of the clinical trials use PET/CT evaluation results to guide whether to conduct consolidation radiotherapy
.
03 Study Conclusions This large comprehensive meta-analysis conducted by the investigators contains the best currently available data from randomized trials of consolidation radiotherapy in the first-line treatment of aggressive lymphoma
.
The analysis did not find evidence that consolidation radiotherapy in unscreened patients has a survival benefit for DLBCL patients, but there is still strong uncertainty
.
Future clinical trials can also explore the role of consolidation radiotherapy in other subgroups of patients, such as mid-term PET/CT positive patients, or high-risk histological types of limited-stage diseases, such as double-hit lymphoma
.
References: Martin D Berger, Sven Trelle, Annina E Büchi, et al.
Impact on survival through consolidation radiotherapy for diffuse large B-cell lymphoma: a comprehensive meta-analysis.
Haematologica.
2021 Jul 1;106(7):1923- 1931.
Poke "read the original text", we make progress together
.
The use of rituximab improves the efficacy and overall survival of DLBCL patients
.
The current standard treatment R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) can cure nearly two-thirds of DLBCL patients
.
So far, attempts at various treatment options including adding new drugs have failed to further improve the prognosis of DLBCL patients
.
Radiotherapy is also an effective treatment for lymphoma, but its role in consolidation therapy in patients with advanced DLBCL after immunochemotherapy is currently uncertain
.
Based on this, some researchers have carried out a meta-analysis to evaluate the value of radiotherapy as a consolidation therapy for patients with advanced DLBCL after immunochemotherapy
.
01 Research methods Researchers used a comprehensive meta-analysis and systematic search of abstracts published in Pubmed, Embase, Cochrane, ASCO, ASH, ESMO, and ASTRO from June 1966 to December 2018 to evaluate radiotherapy in patients with advanced DLBCL immunochemotherapy Consolidate the effect of treatment
.
The researchers identified 11 clinical trials evaluating DLBCL immunochemotherapy and consolidation radiotherapy, of which 4584 patients were from randomized clinical studies
.
The primary endpoint of this meta-analysis is the patient's progression-free survival (PFS)
.
02 Results of the study The meta-analysis included 4584 patients recruited between 1983 and 2013
.
After screening, the data of a total of 2488 patients can be analyzed for PFS.
In the summary bivariate meta-analysis, the summary HR was 0.
77 (95% CI: 0.
51-1.
17) and 0.
80 (95% CI: 0.
53-1.
21) (Figure 1)
.
For the overall survival (OS) analysis, a total of 2744 patients were included.
In the bivariate meta-analysis, the pooled HR was 0.
93 (95% CI: 0.
61-1.
40) and 0.
86 (95% CI: 0.
58-1.
27) (Figure 2)
.
The heterogeneity between the two results is high
.
However, with the passage of time, the lack of benefit of consolidation radiotherapy after immunochemotherapy remains stable, and time alone cannot explain the heterogeneity observed in the meta-analysis
.
Figure 1 The effect of consolidation radiotherapy on PFS Figure 2 The effect of consolidation radiotherapy on OS In view of the significant heterogeneity, the researchers further used stratification to analyze the data: (1) Whether the chemotherapy regimens used by the two groups of patients are similar, (2 ) The use of rituximab in the two groups of patients, (3) the specific dose of radiotherapy, and (4) whether the radiotherapy was performed only after complete morphological remission
.
In addition, the researchers also stratified according to the characteristics of the trial population: (5) the average age of the patients receiving treatment, (6) whether the majority of patients are at an advanced stage, and (7) whether most patients are accompanied by large masses
.
The results of the stratified analysis showed that the heterogeneity between clinical trials could not be explained by stratified analysis of any of these subgroups
.
In addition, none of the clinical trials use PET/CT evaluation results to guide whether to conduct consolidation radiotherapy
.
03 Study Conclusions This large comprehensive meta-analysis conducted by the investigators contains the best currently available data from randomized trials of consolidation radiotherapy in the first-line treatment of aggressive lymphoma
.
The analysis did not find evidence that consolidation radiotherapy in unscreened patients has a survival benefit for DLBCL patients, but there is still strong uncertainty
.
Future clinical trials can also explore the role of consolidation radiotherapy in other subgroups of patients, such as mid-term PET/CT positive patients, or high-risk histological types of limited-stage diseases, such as double-hit lymphoma
.
References: Martin D Berger, Sven Trelle, Annina E Büchi, et al.
Impact on survival through consolidation radiotherapy for diffuse large B-cell lymphoma: a comprehensive meta-analysis.
Haematologica.
2021 Jul 1;106(7):1923- 1931.
Poke "read the original text", we make progress together
