Taverna Josephine A, Yun Seongseok, Jonnadula Jayasree, Saleh Ahlam, Riaz Irbaz Bin, Abraham Ivo, Yeager Andrew M, Persky Daniel O, McBride Ali, Haldar Subrata, Anwer Faiz
Department of Medicine, University of Arizona, Tucson, Arizona; Department of Hematology and Oncology, Blood and Marrow Transplantation Program, University of Arizona, Tucson, Arizona; Department of Hematology and Oncology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
Department of Medicine, University of Arizona, Tucson, Arizona.
Biol Blood Marrow Transplant. 2016 Jul;22(7):1182-1196. doi: 10.1016/j.bbmt.2016.02.007. Epub 2016 Feb 16.
Significant uncertainty exists in regard to the efficacy of maintenance therapy after high-dose chemotherapy (HDC) as well as autologous stem cell transplantation (ASCT) for the treatment of patients with aggressive lymphoma. A systematic review was performed to evaluate the effectiveness of post-ASCT maintenance therapy in patients with relapsed/refractory lymphoma. A comprehensive literature search yielded 4476 studies and a total of 42 studies (11 randomized controlled trials [RCT], 9 retrospective comparative studies, and 22 single-arm studies) were included in the systematic review. There was significant heterogeneity in study design, chemotherapeutic regimens, post-ASCT maintenance strategies, patient enrollment criteria, and study endpoints. Our findings suggest that post-ASCT maintenance immune-targeting strategies, including PD-1/PD-L1 blocking antibodies, rituximab, and brentuximab, may improve progression-free survival but not overall survival. Collectively, the results indicate a need for testing new strategies with well-designed and adequately powered RCTs to better address the role of post-ASCT maintenance in relapsed/refractory lymphomas.
对于大剂量化疗（HDC）以及自体干细胞移植（ASCT）后维持治疗在侵袭性淋巴瘤患者治疗中的疗效，存在重大不确定性。进行了一项系统评价，以评估ASCT后维持治疗在复发/难治性淋巴瘤患者中的有效性。全面的文献检索产生了4476项研究，共有42项研究（11项随机对照试验[RCT]、9项回顾性比较研究和22项单臂研究）纳入了该系统评价。研究设计、化疗方案、ASCT后维持策略、患者纳入标准和研究终点存在显著异质性。我们的研究结果表明，ASCT后维持免疫靶向策略，包括PD-1/PD-L1阻断抗体、利妥昔单抗和brentuximab，可能改善无进展生存期，但不能改善总生存期。总体而言，结果表明需要通过设计良好且有足够效力的RCT来测试新策略，以更好地明确ASCT后维持治疗在复发/难治性淋巴瘤中的作用。
