Department of Hematology, The Third Affiliated Hospital of Kunming Medical University, Kunming, China.
Eur Rev Med Pharmacol Sci. 2020 May;24(9):4921-4930. doi: 10.26355/eurrev_202005_21181.
Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma (NHL). This study aimed to systematically evaluate the efficacy of chimeric antigen receptor T cells (CAR-T) in treating relapse/refractory DLBCL (R/R DLBCL) and associated complete-remission rate (CR).
PubMed, Cochrane Library, CNKI, VIP, CBM, and Wanfang databases were searched, and literature was collected up to January 2019. According to inclusion criteria and exclusion criteria, two researchers independently reviewed and screened literature, extracted required data and crossly checked them. This meta-analysis was conducted using RevMan 5.3 software.
This study finally included 13 English literatures and 263 cases. There was no heterogeneity among all these studies, therefore, fixed effect model was used. Meta-analysis findings showed that total CR rate of R/R DLBCL treated with CAR-T was 46.8% (95% CI: 0.408-0.533). Subgroup analysis showed that CR rate of CD28 group was slightly higher [52.5%, with 95% confidence interval (CI): 0.441-0.602] compared to that of 4-1BB group (41.5%, with 95% CI: 0.324-0.510). CR rate of CD19 group was slightly higher (49.2%, with 95% CI: 0.429-0.556) compared to that of CD20 group (42.2%, with 95% CI: 0.231-0.639). Funnel chart of total CR rate, co-stimulatory factor, and target antigen demonstrated fundamental symmetry. Moreover, age, HSCT administration, CAR-T cell counts, and drug pre-treatment also affected immunotherapy on CAR-T on R/R DLBCL.
CAR-T treatment for R/R DLBCL demonstrated evident curative effect and high complete remission rate. CAR-T cell immunotherapy would be expected to become mainstream therapy for hematolymph system tumors.
弥漫性大 B 细胞淋巴瘤（DLBCL）是最常见的非霍奇金淋巴瘤（NHL）。本研究旨在系统评估嵌合抗原受体 T 细胞（CAR-T）治疗复发/难治性 DLBCL（R/R DLBCL）的疗效及其相关完全缓解率（CR）。
检索 PubMed、Cochrane Library、CNKI、VIP、CBM 和万方数据库，收集截至 2019 年 1 月的文献。根据纳入和排除标准，两名研究人员独立进行文献回顾和筛选，提取所需数据并交叉核对。使用 RevMan 5.3 软件进行荟萃分析。
本研究最终纳入 13 篇英文文献和 263 例病例。所有研究均无异质性，因此采用固定效应模型进行分析。荟萃分析结果显示，R/R DLBCL 患者接受 CAR-T 治疗的总 CR 率为 46.8%（95%CI：0.408-0.533）。亚组分析显示，CD28 组的 CR 率略高于 4-1BB 组[52.5%，95%CI：0.441-0.602]。CD19 组的 CR 率略高于 CD20 组[49.2%，95%CI：0.429-0.556]。CD19 组的 CR 率略高于 CD20 组。总 CR 率、共刺激因子和靶抗原的漏斗图显示基本对称。此外，年龄、HSCT 给药、CAR-T 细胞计数和药物预处理也影响 R/R DLBCL 患者的免疫治疗。
CAR-T 治疗 R/R DLBCL 具有显著疗效和高完全缓解率。CAR-T 细胞免疫疗法有望成为血液淋巴系统肿瘤的主流治疗方法。
