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Preprints

Quantitative evaluation of therapy options for relapsed/refractory diffuse large B-cell lymphoma

Li T, Hou M, Zha S, Cheng Q, Zheng Q, Li L, Yu J.
Preprint from
Research Square
6 May 2022
PPR
PPR489809
Abstract

Background:

The prognosis of patients with relapsed or refractory diffuse large B-cell lymphoma (r/r DLBCL) is still poor, and their treatment options are limited, which highlights the need for new treatments. This study aimed to quantitatively evaluate the efficacy, safety, and related factors of various therapeutic options for patients with r/r DLBCL to provide necessary quantitative information for clinical practice. Methods A literature search was conducted using public databases. The parametric survival function was used to describe the time course of overall survival (OS) and progression-free survival (PFS) in patients with r/r DLBCL receiving various treatment regimens. A random-effects model in a single-arm meta-analysis was used to analyze the objective response rate (ORR) and grade 3–5 adverse event rates based on various treatment regimens. Results A total of 58 studies including 3124 subjects were included. Combination therapy had a significant benefit in terms of OS, PFS, and ORR compared with monotherapy. ORR and PFS were significantly improved in the treatment regimen, including chemotherapy, but OS did not improve, and grade 3–5 adverse events significantly increased. In terms of treatment strategy, the efficacy of chemotherapy combined with immunotherapy sequential autologous stem cell transplantation (ASCT), immunotherapy combined with immunotherapy, chemotherapy sequential ASCT, chemotherapy combined with immunotherapy, and chemotherapy combined with two types of immunotherapy is better. Specific to each treatment regimen, R-inotuzumab ozogamicin, R-BEAM + ASCT, R-ESHAP-L, iodine-131 tositumomab + BEAM + ASCT, and chemotherapy + CAR-T had better efficacy, with median OS of 48.2, 34.2, 27.8, 25.8, and 25 months, respectively. Moreover, there was a strong correlation between the 6-month PFS and 2-year OS in the combination therapy. Conclusions Combination therapy and chemotherapy can significantly improve the efficacy of r/r DLBCL treatment. The 6-month PFS can be used as a surrogate endpoint for the 2-year OS. This study provides the necessary quantitative information for clinical practice and clinical trial design of r/r DLBCL.