a Department of Hematology-Oncology , Azienda Ospedaliera Pugliese-Ciaccio , Catanzaro , Italy.
b Biostatistic Unit , IRCCS Regina Elena , Rome , Italy.
Leuk Lymphoma. 2019 Jul;60(7):1644-1649. doi: 10.1080/10428194.2018.1543882. Epub 2018 Dec 5.
Chronic lymphocytic leukemia (CLL) guidelines highlight the relevance of cytogenetic and molecular testing to identify patients with high-risk genetic features. However, at the moment, only 17p del/ mutation are universally recognized parameters influencing choice of therapy. We conducted a systematic review and meta-analysis assessing the magnitude of improvement in progression-free survival (PFS) with B-cell receptor (BCR) (i.e. ibrutinib and idelalisib) or BCL2 (i.e. venetoclax) pathway inhibitors based on the presence or absence of 17p deletion/ mutations, 11q deletion and mutational status in relapsed/refractory (R/R) CLL patients. Meta-analysis of seven randomized trials comprising 2409 patients with R/R CLL revealed that improvement over traditional treatments observed with BCR or BCL2 pathway inhibitors is common to all patients, including those patients with unfavorable and favorable prognostic parameters. These findings provide quantitative evidence to support the choice of therapy in R/R CLL not solely on the basis of 17p del/ mutations.
慢性淋巴细胞白血病（CLL）指南强调了细胞遗传学和分子检测在确定具有高风险遗传特征的患者中的相关性。然而，目前，只有 17p 缺失/突变是普遍公认的影响治疗选择的参数。我们进行了一项系统评价和荟萃分析，评估了基于是否存在 17p 缺失/突变、11q 缺失和突变状态，在复发/难治性（R/R）CLL 患者中，B 细胞受体（BCR）（即伊布替尼和idelalisib）或 BCL2（即 venetoclax）通路抑制剂在无进展生存期（PFS）方面的改善程度。对包含 2409 例 R/R CLL 患者的 7 项随机试验进行的荟萃分析表明，与传统治疗相比，BCR 或 BCL2 通路抑制剂的改善在所有患者中都很常见，包括那些预后不良和预后良好的患者。这些发现提供了定量证据，支持在 R/R CLL 中选择治疗方案不仅仅基于 17p 缺失/突变。
