Zheng Yan-Hua, Xu Li, Cao Chun, Feng Juan, Tang Hai-Long, Shu Mi-Mi, Gao Guang-Xun, Chen Xie-Qun
Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China,
Onco Targets Ther. 2019 Apr 11;12:2751-2766. doi: 10.2147/OTT.S191179. eCollection 2019.
To evaluate the efficacy and safety of rituximab-based combination therapy for Waldenström macroglobulinemia (WM), we conducted this meta-analysis by pooling the rates of overall response, major response, complete response, and grade ≥3 hematological adverse events.
We searched for relevant studies in the databases of PubMed, Web of Science, Embase, and the Cochrane Library. The qualitative assessment of all the included articles was conducted with reference to the Newcastle-Ottawa Scale. A random-effects model was selected to perform all pooled analyses.
We identified altogether 22 studies with a total of 806 symptomatic WM patients enrolled. The pooled analysis indicated that the rituximab-based combination therapy achieved an overall response rate (ORR) of 84% (95% CI: 81%-87%), a major response rate (MRR) of 71% (95% CI: 66%-75%), and a complete response rate (CRR) of 7% (95% CI: 5%-10%). Rituximab plus conventional alkylating agents-containing chemotherapy (subgroup A) yielded an ORR of 86% (95% CI: 81%-89%), an MRR of 74% (95% CI: 69%-79%), and a CRR of 8% (95% CI: 4%-14%). Rituximab plus purine analog (subgroup B) resulted in an ORR of 85% (95% CI: 79%-89%), an MRR of 74% (95% CI: 66%-81%), and a CRR of 9% (95% CI: 4%-15%). Rituximab plus proteasome inhibitor (subgroup C) resulted in an ORR of 86% (95% CI: 81%-90%), an MRR of 68% (95% CI: 58%-77%), and a CRR of 7% (95% CI: 3%-11%). Rituximab plus immunomodulatory drug (subgroup D) attained relatively lower response rates, with an ORR of 67% (95% CI: 51%-81%), an MRR of 56% (95% CI: 27%-83%), and a CRR of 5% (95% CI: 1%-12%). Common grade ≥3 hematological adverse events consisted of neutropenia (33%, 95% CI: 17%-52%), thrombocytopenia (7%, 95% CI: 3%-11%), and anemia (5%, 95% CI: 3%-9%).
Rituximab in combination with an alkylating agent, purine analog, or proteasome inhibitor is highly effective with tolerable hematological toxicities for WM.
为评估基于利妥昔单抗的联合疗法治疗华氏巨球蛋白血症（WM）的疗效和安全性，我们通过汇总总缓解率、主要缓解率、完全缓解率及≥3级血液学不良事件发生率进行了这项荟萃分析。
我们在PubMed、Web of Science、Embase和Cochrane图书馆数据库中检索相关研究。所有纳入文章的定性评估均参照纽卡斯尔-渥太华量表进行。选用随机效应模型进行所有汇总分析。
我们共纳入22项研究，总计806例有症状的WM患者。汇总分析表明，基于利妥昔单抗的联合疗法总缓解率（ORR）为84%（95%CI：81%-87%），主要缓解率（MRR）为71%（95%CI：66%-75%），完全缓解率（CRR）为7%（95%CI：5%-10%）。利妥昔单抗联合含传统烷化剂的化疗（A组）的ORR为86%（95%CI：81%-89%），MRR为74%（95%CI：69%-79%），CRR为8%（95%CI：4%-14%）。利妥昔单抗联合嘌呤类似物（B组）的ORR为85%（95%CI：79%-89%），MRR为74%（95%CI：66%-81%），CRR为9%（95%CI：4%-15%）。利妥昔单抗联合蛋白酶体抑制剂（C组）的ORR为86%（95%CI：81%-90%），MRR为68%（95%CI：58%-77%），CRR为7%（95%CI：3%-11%）。利妥昔单抗联合免疫调节剂（D组）的缓解率相对较低，ORR为67%（95%CI：51%-81%），MRR为56%（95%CI：27%-83%），CRR为5%（95%CI：1%-12%）。常见的≥3级血液学不良事件包括中性粒细胞减少（33%，95%CI：17%-52%）、血小板减少（7%，95%CI：3%-11%）和贫血（5%，95%CI：3%-9%）。
利妥昔单抗联合烷化剂、嘌呤类似物或蛋白酶体抑制剂治疗WM疗效显著，血液学毒性可耐受。
