Falchi Lorenzo, Ferrajoli Alessandra, Jacobs Ira, Nava-Parada Pilar
Division of Hematology/Oncology, Columbia University Medical Center, New York, NY.
Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX.
Clin Lymphoma Myeloma Leuk. 2018 Aug;18(8):508-518.e14. doi: 10.1016/j.clml.2018.05.009. Epub 2018 May 23.
Combination regimens with anti-CD20 agents might improve the outcomes of patients with relapsed or refractory B-cell malignancies; however, the available comparative clinical evidence is limited. The present review assessed the reported evidence on the efficacy of anti-CD20 monoclonal antibodies combined with chemotherapy for patients with relapsed or refractory chronic lymphocytic leukemia (CLL), follicular lymphoma (FL), or diffuse large B-cell lymphoma (DLBCL), using a rapid evidence assessment approach. MEDLINE, Embase, and the Cochrane Library were searched from January 1, 1997 to July 14, 2017 (English language only). The data identified from randomized controlled trials or single-arm prospective studies are reported as descriptive study summaries, grouped by anti-CD20 agent and outcome (overall response rate, including complete response and partial response; duration of response; survival, including overall survival and progression-free survival). Of 56 included reports, 32 reported on CLL/small lymphocytic lymphoma, 15 on FL, and 11 on DLBCL. Within the study period, 40, 11, and 7 studies evaluated rituximab, ofatumumab, and obinutuzumab, respectively. Substantially more data were available for rituximab-based combination regimens than for either ofatumumab or obinutuzumab. Moreover, substantial heterogeneity was recorded in the study design and backbone chemotherapy. Thus, the available data are inconclusive regarding any potential similarities or differences in efficacy among these anti-CD20 agents for each respective disease. More importantly, only 1 direct comparison among the anti-CD20 agents was identified, emphasizing the need for head-to-head randomized controlled trials of these drugs to inform clinical decision-making for patients with relapsed or refractory B-cell lymphoproliferative disorders.
抗CD20药物联合治疗方案可能会改善复发或难治性B细胞恶性肿瘤患者的预后；然而，现有的比较性临床证据有限。本综述采用快速证据评估方法，评估了关于抗CD20单克隆抗体联合化疗治疗复发或难治性慢性淋巴细胞白血病（CLL）、滤泡性淋巴瘤（FL）或弥漫性大B细胞淋巴瘤（DLBCL）患者疗效的报道证据。检索了1997年1月1日至2017年7月14日的MEDLINE、Embase和Cochrane图书馆（仅英文文献）。从随机对照试验或单臂前瞻性研究中识别的数据以描述性研究摘要的形式报告，按抗CD20药物和结果分组（总缓解率，包括完全缓解和部分缓解；缓解持续时间；生存率，包括总生存率和无进展生存率）。在纳入的56篇报告中，32篇报告了CLL/小淋巴细胞淋巴瘤，15篇报告了FL，11篇报告了DLBCL。在研究期间，分别有40、11和7项研究评估了利妥昔单抗、奥法木单抗和奥妥珠单抗。与奥法木单抗或奥妥珠单抗相比，基于利妥昔单抗的联合治疗方案有更多的数据。此外，在研究设计和基础化疗方面存在显著的异质性。因此，关于这些抗CD20药物在每种疾病中的疗效是否存在潜在的相似性或差异，现有数据尚无定论。更重要的是，仅确定了一项抗CD20药物之间的直接比较，强调需要对这些药物进行头对头的随机对照试验，以为复发或难治性B细胞淋巴增殖性疾病患者的临床决策提供依据。
