Liang Liang, Zhao Ming, Zhu Yuan-Chao, Hu Xin, Yang Li-Ping, Liu Hui
Department of Pharmacy, Assessment of Clinical Drugs Risk and Individual Application Key Laboratory, Beijing Hospital, Beijing, 100730, China.
Department of Hematology, Beijing Hospital, Beijing, 100730, China.
Ann Hematol. 2016 Sep;95(9):1473-82. doi: 10.1007/s00277-016-2719-6. Epub 2016 Jun 21.
Therapeutic results of relapsed/refractory chronic lymphocytic leukemia (CLL) are very disappointing at present. Lenalidomide has been proved to be effective for relapsed/refractory CLL as a single agent or in combination with various chemo-immunotherapeutic regimens. However, current clinical experience in its usage is still limited. Because of existing considerable variability in different studies, a systematic review and meta-analysis was conducted to describe overall response rate (ORR) of lenalidomide in patients with relapsed/refractory CLL. Pooled estimate of cumulative prevalence of total ORR was 42.23 % (95 % confidence interval [CI], 32.49-52.61 %), while pooled ORR in regimen with lenalidomide plus anti-CD20 monoclonal antibody (mAbs) and lenalidomide mono-therapy were 60.01 % (95 % CI, 53.86-65.86 %) and 24.38 % (95 % CI, 16.15-35.06 %), respectively. There was no significant difference between L + R (lenalidomide plus rituximab) group and L + O (lenalidomide plus ofatumumab) group, with pooled ORR of 66.38 % (95 % CI, 57.96-73.87 %) and 57.40 % (95 % CI, 46.46-67.65 %), respectively. When co-administrated with anti-CD20 mAbs, dosage of lenalidomide was not the key factor of ORR in combination therapy. Pooled ORR of patient with high-risk cytogenetic in L + anti-CD20 mAbs group was 56.74 % (95 % CI, 45.53-67.30 %). In comparison with patients without high-risk cytogenetic receiving the same treatment regimen, no significant difference was observed, with relative risk (RR) of 0.87 (95 % CI 0.68-1.11). Our finding demonstrated that lenalidomide plus anti-CD20 mAbs could be an efficient therapy regimen for relapsed/refractory CLL patients, especially for those with high-risk cytogenetic factor.
目前，复发/难治性慢性淋巴细胞白血病（CLL）的治疗效果非常令人失望。来那度胺已被证明作为单一药物或与各种化疗免疫治疗方案联合使用对复发/难治性CLL有效。然而，目前其使用的临床经验仍然有限。由于不同研究存在相当大的差异，因此进行了一项系统评价和荟萃分析，以描述来那度胺在复发/难治性CLL患者中的总缓解率（ORR）。总ORR累积患病率的合并估计值为42.23%（95%置信区间[CI]，32.49 - 52.61%），而来那度胺联合抗CD20单克隆抗体（mAbs）方案和来那度胺单药治疗的合并ORR分别为60.01%（95%CI，53.86 - 65.86%）和24.38%（95%CI，16.15 - 35.06%）。来那度胺联合利妥昔单抗（L + R）组和来那度胺联合奥法木单抗（L + O）组之间无显著差异，合并ORR分别为66.38%（95%CI，57.96 - 73.87%）和57.40%（95%CI，46.46 - 67.65%）。与抗CD20 mAbs联合使用时，来那度胺的剂量不是联合治疗中ORR的关键因素。L + 抗CD20 mAbs组中具有高危细胞遗传学特征患者的合并ORR为56.74%（95%CI，45.53 - 67.30%）。与接受相同治疗方案的无高危细胞遗传学特征患者相比，未观察到显著差异，相对危险度（RR）为0.87（95%CI 0.68 - 1.11）。我们的研究结果表明，来那度胺联合抗CD20 mAbs可能是复发/难治性CLL患者的一种有效治疗方案，尤其是对于那些具有高危细胞遗传学因素的患者。
