Yin Li, Chunfan Li, Kebing Lv, Shixuan Wang, Fei Li
{"title":"伊布替尼作为单药或联合疗法治疗复发/难治性弥漫大B细胞淋巴瘤(R/R DLBCL)的疗效和安全性:系统综述与元分析》。","authors":"Yin Li, Chunfan Li, Kebing Lv, Shixuan Wang, Fei Li","doi":"10.1097/MJT.0000000000001831","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Diffuse large B-cell lymphoma (DLBCL) is a highly heterogeneous disease group. Ibrutinib's monotherapy or combination therapy is effective in relapsed/refractory (R/R) DLBCL. However, the treatment response in R/R DLBCL varies from 15% to 90% with different regimens, and the tolerance remains controversial.</p><p><strong>Areas of uncertainty: </strong>The efficacy and safety of ibrutinib monotherapy or combination therapy in patients with R/R DLBCL remain uncertain.</p><p><strong>Data sources: </strong>The PubMed, CBM, MEDLINE, Cochrane Library, and Embase databases were searched from their inception to July 2021.</p><p><strong>Therapeutic advances: </strong>The total complete remission rate (CRR) and overall response rate in R/R DLBCL patients treated with ibrutinib were 26% and 49%, respectively. The CRR of ibrutinib combination therapy was significantly higher than the ibrutinib monotherapy (45% vs. 19%). Moreover, the CRR of patients was 40% in double expressing lymphoma, 35% in central nervous system lymphoma, and 33% in nongerminal center B-cell-like (non-GCB) DLBCL, which was higher than the 8% in those with the GCB subtype. The pooled median PFS and overall survival were 5.57 and 10.17 months, respectively. GCB-DLBCL had the worst overall survival (5.1 months). Nevertheless, we found that combination regimens had no survival advantage compared with monotherapy (P > 0.05), indicating that combination therapy was only a transitional treatment and bridge for chimeric antigen receptor T cells or other treatments. Moreover, 12% of patients on ibrutinib combination therapy had ≥grade 3 adverse events compared with 9% on ibrutinib monotherapy.</p><p><strong>Conclusions: </strong>Ibrutinib monotherapy or combination therapy was safe and effective in treating R/R DLBCL with tolerable adverse reactions.</p>","PeriodicalId":7760,"journal":{"name":"American journal of therapeutics","volume":null,"pages":null},"PeriodicalIF":2.9000,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy and Safety of Ibrutinib as Monotherapy or Combination Therapy in Relapsed/Refractory Diffuse Large B-cell Lymphoma (R/R DLBCL): A Systematic Review and Meta-analysis.\",\"authors\":\"Yin Li, Chunfan Li, Kebing Lv, Shixuan Wang, Fei Li\",\"doi\":\"10.1097/MJT.0000000000001831\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Diffuse large B-cell lymphoma (DLBCL) is a highly heterogeneous disease group. Ibrutinib's monotherapy or combination therapy is effective in relapsed/refractory (R/R) DLBCL. However, the treatment response in R/R DLBCL varies from 15% to 90% with different regimens, and the tolerance remains controversial.</p><p><strong>Areas of uncertainty: </strong>The efficacy and safety of ibrutinib monotherapy or combination therapy in patients with R/R DLBCL remain uncertain.</p><p><strong>Data sources: </strong>The PubMed, CBM, MEDLINE, Cochrane Library, and Embase databases were searched from their inception to July 2021.</p><p><strong>Therapeutic advances: </strong>The total complete remission rate (CRR) and overall response rate in R/R DLBCL patients treated with ibrutinib were 26% and 49%, respectively. The CRR of ibrutinib combination therapy was significantly higher than the ibrutinib monotherapy (45% vs. 19%). Moreover, the CRR of patients was 40% in double expressing lymphoma, 35% in central nervous system lymphoma, and 33% in nongerminal center B-cell-like (non-GCB) DLBCL, which was higher than the 8% in those with the GCB subtype. The pooled median PFS and overall survival were 5.57 and 10.17 months, respectively. GCB-DLBCL had the worst overall survival (5.1 months). Nevertheless, we found that combination regimens had no survival advantage compared with monotherapy (P > 0.05), indicating that combination therapy was only a transitional treatment and bridge for chimeric antigen receptor T cells or other treatments. Moreover, 12% of patients on ibrutinib combination therapy had ≥grade 3 adverse events compared with 9% on ibrutinib monotherapy.</p><p><strong>Conclusions: </strong>Ibrutinib monotherapy or combination therapy was safe and effective in treating R/R DLBCL with tolerable adverse reactions.</p>\",\"PeriodicalId\":7760,\"journal\":{\"name\":\"American journal of therapeutics\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2024-10-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American journal of therapeutics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/MJT.0000000000001831\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PHARMACOLOGY & PHARMACY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of therapeutics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/MJT.0000000000001831","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 0
摘要
背景:弥漫大 B 细胞淋巴瘤(DLBCL弥漫大B细胞淋巴瘤(DLBCL)是一种高度异质性疾病。伊布替尼单药或联合疗法对复发/难治(R/R)DLBCL有效。然而,不同方案对R/R DLBCL的治疗反应从15%到90%不等,耐受性仍存在争议:伊布替尼单药治疗或联合治疗对R/R DLBCL患者的疗效和安全性仍不确定:数据来源:对PubMed、CBM、MEDLINE、Cochrane Library和Embase数据库从开始到2021年7月的数据进行了检索:接受伊布替尼治疗的R/R DLBCL患者的总完全缓解率(CRR)和总反应率分别为26%和49%。伊布替尼联合疗法的CRR明显高于伊布替尼单药疗法(45%对19%)。此外,双表达淋巴瘤患者的CRR为40%,中枢神经系统淋巴瘤患者的CRR为35%,非皮层中心B细胞样(非GCB)DLBCL患者的CRR为33%,均高于GCB亚型患者的8%。汇总的中位生存期和总生存期分别为5.57个月和10.17个月。GCB-DLBCL的总生存期最短(5.1个月)。然而,我们发现联合疗法与单一疗法相比没有生存优势(P > 0.05),这表明联合疗法只是一种过渡性疗法,是嵌合抗原受体T细胞或其他疗法的桥梁。此外,与接受伊布替尼单药治疗的9%患者相比,接受伊布替尼联合治疗的12%患者出现了≥3级不良事件:伊布替尼单药或联合疗法治疗R/R DLBCL安全有效,不良反应可耐受。
Efficacy and Safety of Ibrutinib as Monotherapy or Combination Therapy in Relapsed/Refractory Diffuse Large B-cell Lymphoma (R/R DLBCL): A Systematic Review and Meta-analysis.
Background: Diffuse large B-cell lymphoma (DLBCL) is a highly heterogeneous disease group. Ibrutinib's monotherapy or combination therapy is effective in relapsed/refractory (R/R) DLBCL. However, the treatment response in R/R DLBCL varies from 15% to 90% with different regimens, and the tolerance remains controversial.
Areas of uncertainty: The efficacy and safety of ibrutinib monotherapy or combination therapy in patients with R/R DLBCL remain uncertain.
Data sources: The PubMed, CBM, MEDLINE, Cochrane Library, and Embase databases were searched from their inception to July 2021.
Therapeutic advances: The total complete remission rate (CRR) and overall response rate in R/R DLBCL patients treated with ibrutinib were 26% and 49%, respectively. The CRR of ibrutinib combination therapy was significantly higher than the ibrutinib monotherapy (45% vs. 19%). Moreover, the CRR of patients was 40% in double expressing lymphoma, 35% in central nervous system lymphoma, and 33% in nongerminal center B-cell-like (non-GCB) DLBCL, which was higher than the 8% in those with the GCB subtype. The pooled median PFS and overall survival were 5.57 and 10.17 months, respectively. GCB-DLBCL had the worst overall survival (5.1 months). Nevertheless, we found that combination regimens had no survival advantage compared with monotherapy (P > 0.05), indicating that combination therapy was only a transitional treatment and bridge for chimeric antigen receptor T cells or other treatments. Moreover, 12% of patients on ibrutinib combination therapy had ≥grade 3 adverse events compared with 9% on ibrutinib monotherapy.
Conclusions: Ibrutinib monotherapy or combination therapy was safe and effective in treating R/R DLBCL with tolerable adverse reactions.
期刊介绍:
American Journal of Therapeutics is an indispensable resource for all prescribing physicians who want to access pharmacological developments in cardiology, infectious disease, oncology, anesthesiology, nephrology, toxicology, and psychotropics without having to sift through stacks of medical journals. The journal features original articles on the latest therapeutic approaches as well as critical articles on the drug approval process and therapeutic reviews covering pharmacokinetics, regulatory affairs, pediatric clinical pharmacology, hypertension, metabolism, and drug delivery systems.