Liu Hailing, Shi Xiao, Fang Huizi, Cao Lei, Miao Yi, Zhao Xiaoli, Wu Wei, Xu Wei, Li Jianyong, Fan Lei
Department of Hematology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China.
Nanjing Pukou District Central Hospital, Pukou Branch of Jiangsu Province Hospital, Pukou CLL Center, Nanjing, China.
Front Oncol. 2022 May 11;12:881346. doi: 10.3389/fonc.2022.881346. eCollection 2022.
In the era of immunotherapy, autologous stem cell transplantation (ASCT) in first-line therapy in patients with mantle cell lymphoma (MCL) has been a controversial topic. This report aimed to explore the association between ASCT and MCL survival through a systematic review with meta-analysis.
We performed a systematic search of original articles published from inception to September 2021 using PubMed, MEDLINE, Embase, and Cochrane Library databases.
We included studies that compared ASCT with non-ASCT consolidation in newly diagnosed transplant-eligible MCL. The endpoints were progression-free survival (PFS) and overall survival (OS). There were seven eligible studies (one randomized clinical trial, one prospective cohort study, and five observational studies) published between 2012 and 2021, in which the total number of participants was 3,271. In the non-intensive induction subgroup, patients with ASCT experienced a significant PFS but no OS benefit compared with those without ASCT. In the intensive induction subgroup, the PFS benefit from ASCT still existed but largely attenuated; no OS benefit was observed though only one study was suitable for evaluation. When compared to the rituximab maintenance arm, ASCT had a worse PFS and OS.
In the rituximab plus HiDAC era, the benefit of ASCT as a component of first-line treatment has been weakened. First-line maintenance strategy instead of ASCT seems worth exploring .
在免疫治疗时代，套细胞淋巴瘤（MCL）患者一线治疗中自体干细胞移植（ASCT）一直是一个有争议的话题。本报告旨在通过系统评价和荟萃分析探讨ASCT与MCL生存之间的关联。
我们使用PubMed、MEDLINE、Embase和Cochrane图书馆数据库对从创刊到2021年9月发表的原始文章进行了系统检索。
我们纳入了比较新诊断的适合移植的MCL患者中ASCT与非ASCT巩固治疗的研究。终点指标为无进展生存期（PFS）和总生存期（OS）。2012年至2021年期间发表了7项符合条件的研究（1项随机临床试验、1项前瞻性队列研究和5项观察性研究），参与者总数为3271人。在非强化诱导亚组中，与未接受ASCT的患者相比，接受ASCT的患者PFS显著延长，但OS无获益。在强化诱导亚组中，ASCT带来的PFS获益仍然存在，但大幅减弱；尽管只有1项研究适合评估，但未观察到OS获益。与利妥昔单抗维持治疗组相比，ASCT的PFS和OS更差。
在利妥昔单抗加高强度阿糖胞苷时代，ASCT作为一线治疗组成部分的获益已经减弱。一线维持治疗策略而非ASCT似乎值得探索。
