Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
BMC Ophthalmol. 2023 Nov 22;23(1):477. doi: 10.1186/s12886-023-03226-3.
Vitreoretinal lymphoma (VRL) is usually treated with a combination of intraocular methotrexate (ioMTX), high-dose intravenous methotrexate (HD-MTX), or local radiotherapy (RT) as the first options. The effectiveness and safety of monotherapy like bruton's tyrosine kinase inhibitors (BTKi) for PVRL remain uncertain.
A systematic review and meta-analysis of clinical trial data and conference abstracts in VRL patients treated with first-line combination therapy or monotherapy were conducted through a search of PubMed, Embase, and Scopus databases until December 2022. A total of 24 studies comprising 517 patients were included, and survival data were extracted from 279 patients due to inconsistent units across studies.
The combined treatment group used ioMTX + chemotherapy (in 4 studies), RT + chemotherapy (in 2 studies), ioMTX/HD-MTX based regimen (in 2 studies), ioMTX + RT + chemotherapy (in 2 studies), ioMTX + lenalidomide/BTKi (in 2 studies) and combination of multiple therapies (in 7 studies). The monotherapy group was mainly treated with oral monotherapies such as BTKi. The combination therapy had a higher overall response rate (ORR) and complete response rate (CRR) than monotherapy (ORR: 96% vs. 72%, CRR: 92% vs. 63%). Combination therapy also resulted in a longer median progression-free survival (28.8 months vs. 13 months, p = 0.012). However, the combination therapy group had more severe side effects (grade 3/4 toxicity) than the monotherapy group (45% vs. 8%).
The study showed combination therapy had better OR and CR rates, longer survival, and more toxicity than monotherapy. While BTK inhibitors were well-tolerated, long-term effectiveness needs confirmation from prospective studies. In addition, given the small number of studies of monotherapy for VRL, more studies are needed to validate its effects.
CRD42023400305.
眼内淋巴瘤（VRL）通常采用眼内甲氨蝶呤（ioMTX）、大剂量静脉甲氨蝶呤（HD-MTX）和局部放疗（RT）联合治疗作为首选方案。对于原发性 VRL 患者，单药治疗如 Bruton 酪氨酸激酶抑制剂（BTKi）的疗效和安全性仍不确定。
通过检索 PubMed、Embase 和 Scopus 数据库，对一线联合治疗或单药治疗 VRL 患者的临床试验数据和会议摘要进行系统评价和荟萃分析，检索截止日期为 2022 年 12 月。共纳入 24 项研究，包括 517 例患者，由于研究间单位不一致，从 279 例患者中提取生存数据。
联合治疗组采用 ioMTX+化疗（4 项研究）、RT+化疗（2 项研究）、基于 ioMTX/HD-MTX 的方案（2 项研究）、ioMTX/HD-MTX+RT+化疗（2 项研究）、ioMTX+来那度胺/BTKi（2 项研究）和多种疗法联合（7 项研究）。单药治疗组主要采用 BTKi 等口服单药治疗。联合治疗组的总缓解率（ORR）和完全缓解率（CRR）高于单药治疗组（ORR：96% vs. 72%，CRR：92% vs. 63%）。联合治疗组的中位无进展生存期（PFS）也更长（28.8 个月 vs. 13 个月，p=0.012）。然而，联合治疗组的不良反应（3/4 级毒性）发生率高于单药治疗组（45% vs. 8%）。
该研究表明，与单药治疗相比，联合治疗具有更高的 OR 和 CR 率、更长的生存期和更多的毒性。BTKi 抑制剂具有良好的耐受性，但长期疗效仍需前瞻性研究证实。此外，由于原发性 VRL 单药治疗的研究数量较少，还需要更多的研究来验证其疗效。
CRD42023400305。
