Joan and Sanford I. Weill Department of Medicine.
Department of Healthcare Policy and Research.
Blood Adv. 2018 Jun 26;2(12):1429-1438. doi: 10.1182/bloodadvances.2018016683.
Lenalidomide is associated with increased risk of thromboembolism (VTE) in patients with multiple myeloma. This risk has not previously been defined in B-cell non-Hodgkin lymphoma (NHL), for which lenalidomide is also an active agent. We conducted a systematic literature search in Ovid MEDLINE (1946 to February 2017), Ovid EMBASE (1974 to February 2017), The Cochrane Library (Wiley), and Web of Science Core Collection for prospective studies evaluating lenalidomide-containing regimens in B-cell NHL with adequate reporting of patient characteristics, total cycles received, and safety data including VTE rates. The primary outcome was VTE events per 100 patient-cycles by meta-analysis using random-effects models. Our literature search identified 1719 citations; 28 articles were included. For all patients with B-cell NHL receiving lenalidomide, the rate of VTE per 100 patient-cycles was 0.77 (95% confidence interval [CI], 0.48-1.12; I, 67%). The rate for single-agent lenalidomide was 1.09 events per 100 patient-cycles (95% CI, 0.49-1.94; I, 76%), the rate for lenalidomide plus biologics was 0.49 (95% CI, 0.17-0.97; I, 59%), and the rate for lenalidomide plus chemotherapy was 0.89 (95% CI, 0.39-1.60; I, 57%). Rate of VTE events in B-cell NHL patients treated with lenalidomide in clinical trials is similar to the rate in multiple myeloma. The VTE rate appears to be lowest for lenalidomide combined with a biologic compared with single-agent lenalidomide or its combination with chemotherapy. This protocol was registered at www.crd.york.ac.uk/prospero/ as #CRD42017056042.
来那度胺与多发性骨髓瘤患者的血栓栓塞事件（VTE）风险增加相关。此前，来那度胺在 B 细胞非霍奇金淋巴瘤（NHL）中的应用也被证明是有效的，但尚未明确其与 VTE 风险的相关性。我们在 Ovid MEDLINE（1946 年至 2017 年 2 月）、Ovid EMBASE（1974 年至 2017 年 2 月）、The Cochrane Library（Wiley）和 Web of Science 核心合集进行了系统性文献检索，以查找前瞻性研究，这些研究评估了包含来那度胺的方案在 B 细胞 NHL 中的应用，这些研究充分报告了患者特征、接受的总周期数以及包括 VTE 发生率在内的安全性数据。主要结局通过使用随机效应模型的荟萃分析，以每 100 患者周期的 VTE 事件数表示。我们的文献检索共确定了 1719 条引用，其中 28 篇文章被纳入。所有接受来那度胺治疗的 B 细胞 NHL 患者中，VTE 发生率为每 100 患者周期 0.77（95%置信区间[CI]，0.48-1.12；I ² =67%）。单用来那度胺的发生率为每 100 患者周期 1.09 例（95%CI，0.49-1.94；I ² =76%），来那度胺联合生物制剂的发生率为 0.49（95%CI，0.17-0.97；I ² =59%），来那度胺联合化疗的发生率为 0.89（95%CI，0.39-1.60；I ² =57%）。临床试验中接受来那度胺治疗的 B 细胞 NHL 患者的 VTE 发生率与多发性骨髓瘤相似。与单用来那度胺或与化疗联合应用相比，来那度胺联合生物制剂的 VTE 发生率似乎最低。本方案已在 www.crd.york.ac.uk/prospero/ 注册，注册号为 CRD42017056042。
