Department of Hematology, West China Hospital, Sichuan University, Chengdu, China.
Cancer Med. 2023 Jul;12(14):15107-15116. doi: 10.1002/cam4.6183. Epub 2023 Jun 1.
There is no standard first-line immunochemotherapy regimen for transplant-ineligible patients with mantle cell lymphoma (MCL) currently, and the efficacy of various treatment remains unclear.
We conducted a Bayesian network meta-analysis (NMA) of all eligible randomized controlled trials. Pairwise comparisons and ranking of different first-line treatment options were performed.
Nine studies were included in the NMA, involving a total of 2897 MCL patients. The BR-Ibrutinib+R regimen showed the best progression-free survival (PFS), with a surface under the cumulative ranking curve (SUCRA) of 0.89 and probability of being the best treatment (PbBT) of 69%. The VR-CAP regimen was the most potential intervention to improve overall survival (OS), with a SUCRA of 0.89 and PbBT of 63%. Compared with the R-CHOP regimen, the BR regimen achieved a better PFS (hazard ratio [HR] 0.45 [95% credible interval 0.2-0.96]). The BR-Ibrutinib+R regimen (HR 0.14 [0.02-0.99]), BR+R regimen (HR 0.19 [0.034-0.99]), and BR regimen (HR 0.3 [0.08-1.03]) were superior to CHOP regimen with better PFS. The R-FC regimen (HR 2.27 [1.01-5.21]) or FC regimen (HR 3.17 [1.15-8.71]) was inferior to the VR-CAP regimen with a worse OS.
Our study presents the most promising first-line treatment strategy for transplant-ineligible MCL patients in terms of PFS and OS, which provides innovative treatment strategy for MCL treatment.
目前，不适合移植的套细胞淋巴瘤（MCL）患者尚无标准的一线免疫化疗方案，各种治疗方法的疗效尚不清楚。
我们对所有合格的随机对照试验进行了贝叶斯网络荟萃分析（NMA）。进行了两两比较和不同一线治疗方案的排序。
NMA 纳入了 9 项研究，共纳入了 2897 例 MCL 患者。BR-Ibrutinib+R 方案显示出最佳的无进展生存期（PFS），累积排序曲线下面积（SUCRA）为 0.89，最佳治疗概率（PbBT）为 69%。VR-CAP 方案是最有可能改善总生存期（OS）的干预措施，SUCRA 为 0.89，PbBT 为 63%。与 R-CHOP 方案相比，BR 方案的 PFS 更好（风险比[HR]0.45[95%可信区间 0.2-0.96]）。BR 方案（HR 0.14[0.02-0.99]）、BR+R 方案（HR 0.19[0.034-0.99]）和 BR 方案（HR 0.3[0.08-1.03]）的 PFS 优于 CHOP 方案，BR-Ibrutinib+R 方案（HR 0.14[0.02-0.99]）的 PFS 优于 CHOP 方案。R-FC 方案（HR 2.27[1.01-5.21]）或 FC 方案（HR 3.17[1.15-8.71]）的 OS 差于 VR-CAP 方案。
根据 PFS 和 OS，我们的研究为不适合移植的 MCL 患者提出了最有前途的一线治疗策略，为 MCL 治疗提供了创新的治疗策略。
