慢性淋巴细胞白血病的维持疗法
Cho-Hao Lee1, Yi-Ying Wu1, Tzu-Chuan Huang1
1Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
The Cochrane database of systematic reviews
|January 4, 2024
概括
使用抗CD20单克隆抗体 (mAbs) 或免疫调节药物 (IMiDs) 治疗慢性淋巴细胞白血病 (CLL) 的维持疗法可以改善无进展生存率 (PFS),但会增加不良事件 (AE). 在这些CLL治疗中没有观察到总生存 (OS) 益处.
科学领域:
- 血液学 血液学 血液学
- 在瘤学瘤学.
- 临床试验 临床试验
背景情况:
- 慢性淋巴细胞白血病 (CLL) 是一种无法治愈的淋巴增殖性疾病,需要有效的治疗策略.
- 正在探索维持疗法,以延长CLL患者实现缓解的响应持续时间.
- 对于CLL的各种维护疗法的益处和危害仍然不确定.
研究的目的:
- 评估CLL患者的维持疗法的疗效和安全性.
- 包括治疗方法:抗CD20单克隆抗体,免疫调节药物,抗CD52单克隆抗体,布鲁顿氨酸激酶抑制剂和B细胞淋巴瘤-2氨酸激酶抑制剂.
主要方法:
- 在多个数据库中对随机对照试验 (RCT) 进行全面的文献搜索.
- 包括RCT比较了维持疗法与安慰剂/观察或对比治疗.
- 偏差风险和证据确定性 (GRADE) 对OS,PFS和AE等结果进行评估.
主要成果:
- 包括11个RCT (2393名参与者);没有发现新型小分子抑制剂的试验.
- 抗CD20mAbs维护改善了PFS (中度确定性),但增加了3/4级和所有AE (低确定性).
- 免疫调节药物 (利那利多米德) 的维持显著增加了PFS (中度确定性) 和3/4级AE (低确定性).
结论:
- 中等至非常低的确定性证据表明,抗CD20mAbs和IMiD维护可以改善CLL中的PFS,但会增加AEs.
- 对于这些疗法,维持和控制组之间没有观察到总生存时间 (OS) 的显著差异.
- 维护阿勒姆图祖马布的效果是不确定的,没有发现其他新型向疗法的研究.
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