利妥昔单抗治疗儿童及青少年成熟B细胞非霍奇金淋巴瘤疗效及安全性的Meta分析

Efficacy and safety of rituximab in children and adolescents with mature B-cell non-Hodgkin's lymphoma: a Meta analysis

摘要:

目的 通过Meta分析探讨在儿童及青少年成熟B细胞非霍奇金淋巴瘤治疗中应用利妥昔单抗联合化疗的疗效与安全性，为更加合理地应用利妥昔单抗提供理论依据。方法 检索PubMed、Embase、Cochrane Library、ClinicalTrials.gov、Web of Science、中国知网、万方、维普数据库的文献，共筛选出从建库至2022年6月公开发表的利妥昔单抗治疗儿童及青少年成熟B细胞非霍奇金淋巴瘤的10篇文献，共计886例患儿。以3年无事件生存率、3年总生存率、完全缓解率、病死率和不良反应发生率作为结局指标，采用RevMan 5.4软件进行Meta分析、亚组分析、敏感性分析和发表偏倚分析。结果 与单纯化疗组相比，利妥昔单抗联合化疗组3年无事件生存率显著提高（HR=0.38，95%CI：0.25~0.59，P<0.001），3年总生存率显著提高（HR=0.29，95%CI：0.14~0.61，P=0.001），完全缓解率显著提高（OR=3.72，95%CI：1.89~7.33，P<0.001），病死率显著降低（OR=0.31，95%CI：0.17~0.57，P<0.001）。而两组的不良反应发生率差异无统计学意义（OR=1.28，95%CI：0.85~1.92，P=0.24）。结论 在儿童及青少年成熟B细胞非霍奇金淋巴瘤治疗方案中添加利妥昔单抗可带来明显的生存益处，且不会增加不良反应的发生。

Abstract:

Objective To study the efficacy and safety of rituximab combined with chemotherapy in the treatment of children and adolescents with mature B-cell non-Hodgkin's lymphoma (B-NHL) through a Meta analysis.Methods The databases including PubMed, Embase, the Cochrane Library, ClinicalTrials.gov, Web of Science, China National Knowledge Infrastructure, Wanfang Data, and Weipu were searched to obtain 10 articles on rituximab in the treatment of mature B-NHL in children and adolescents published up to June 2022, with 886 children in total. With 3-year event-free survival (EFS) rate, 3-year overall survival (OS) rate, complete remission rate, mortality rate, and incidence rate of adverse reactions as outcome measures, RevMan 5.4 software was used for Meta analysis, subgroup analysis, sensitivity analysis, and publication bias analysis.Results The rituximab+chemotherapy group showed significant increases in the 3-year EFS rate (HR=0.38, 95%CI: 0.25-0.59, P<0.001), 3-year OS rate (HR=0.29, 95%CI: 0.14-0.61, P=0.001), and complete remission rate (OR=3.72, 95%CI: 1.89-7.33, P<0.001) as well as a significant reduction in the mortality rate (OR=0.31, 95%CI: 0.17-0.57, P<0.001), as compared with the chemotherapy group without rituximab. There was no significant difference in the incidence rate of adverse reactions between the two groups (OR=1.28, 95%CI: 0.85-1.92, P=0.24).Conclusions The addition of rituximab to the treatment regimen for children and adolescents with mature B-cell non-Hodgkin's lymphoma can bring significant survival benefits without increasing the incidence of adverse reactions.