目的:综述文献支持原发性中枢神经系统淋巴瘤(PCNSL)的治疗方案,包括诱导化疗,随后进行一次巩固治疗。自体干细胞移植(ASCT)支持的大剂量化疗是研究最多的选择,但是它的影响是有争议的。这项研究的目的是通过荟萃分析评估ASCT用于新诊断的PCNSL的有效性和安全性。
方法:PubMed,Embase,和Cochrane图书馆数据库进行了系统搜索,以获取直到2021年5月20日发表的研究。纳入的研究是对接受ASCT治疗的新诊断PCNSL患者的前瞻性研究。确定所有结果的合并率和95%置信区间(CI)。进行亚组分析,比较完全缓解率(CR)的相对风险(RR)和95%CI,以及无进展生存期(PFS)和总生存期(OS)的风险比(HRs)和95%CI。
结果:分析了包括348例患者在内的13项前瞻性研究。合并的CR率,总反应率,复发率为80%(95%CI,71-88%,I2=67.06%,p=0.00),95%(95%CI,87-100%,I2=73.65%,p=0.00),和19%(95%CI,15-24%,I2=76.18%,p=0.00),分别。合并的2年和5年PFS和OS率为74%(95%CI,68-80%,I2=3.90%),65%(95%CI,51-77%,I2=74.61%),80%(95%CI,72-88%,I2=57.54%),和69%(95%CI,53-83%,I2=83.89%),分别。血液学毒性和感染是3级以上更常见的不良事件。合并治疗相关死亡率为3%(95%CI,1-6%,I2=28.18%,p=0.16)。在ASCT与全脑放疗的分组分析中,CR率无显著差异(RR,1.00,95%CI,0.88-1.14,p=0.971),复发率(RR,0.44,95%CI,0.06-3.10,p=0.408),PFS(HR,1.28,95%CI,0.81-2.01,p=0.29),或操作系统(HR,1.62,95%CI,0.97-2.69,p=0.06)。ASCT后认知功能得到保留或改善。
结论:ASCT是一种可行的合并方法,对新诊断的PCNSL患者具有良好的耐受性。仍需要高质量的随机对照试验来证实ASCT的疗效。
背景:https://www.crd.约克。AC.英国/普华永道/,标识符CRD42021268422。
OBJECTIVE: The reviewed literature supports a treatment regimen for primary central nervous system lymphoma (PCNSL) that includes induction chemotherapy, followed by one consolidation therapy. High-dose chemotherapy supported by autologous stem-cell transplantation (ASCT) is the most studied option, but its effects are controversial. The aim of this study was to evaluate the efficacy and safety of ASCT for newly diagnosed PCNSL by means of a meta-analysis.
METHODS: The PubMed, Embase, and Cochrane Library databases were systematically searched for studies published until May 20, 2021. Included studies were prospective studies of patients with newly diagnosed PCNSL treated with ASCT. The pooled rates and 95% confidence intervals (CIs) were determined for all outcomes. Subgroup analysis was conducted to compare the relative risk (RR) with 95% CIs for the complete remission (CR) rate and the hazard ratios (HRs) with 95% CIs for progression-free survival (PFS) and overall survival (OS).
RESULTS: Thirteen prospective studies including 348 patients were analyzed. The pooled CR rate, overall response rate, and relapse rate were 80% (95% CI, 71-88%, I2 = 67.06%, p = 0.00), 95% (95% CI, 87-100%, I2 = 73.65%, p= 0.00), and 19% (95% CI, 15-24%, I2 = 76.18%, p = 0.00), respectively. The pooled 2- and 5-year PFS and OS rates were 74% (95% CI, 68-80%, I2 = 3.90%), 65% (95% CI, 51-77%, I2 = 74.61%), 80% (95% CI, 72-88%, I2 = 57.54%), and 69% (95% CI, 53-83%, I2 = 83.89%), respectively. Hematological toxicity and infections were more common adverse events above grade 3. The pooled treatment-related mortality was 3% (95% CI, 1-6%, I2 = 28.18%, p = 0.16). In the group analysis of ASCT compared with whole-brain radiotherapy, there were no significant differences in the CR rate (RR, 1.00, 95% CI, 0.88-1.14, p = 0.971), relapse rate (RR, 0.44, 95% CI, 0.06-3.10, p = 0.408), PFS (HR, 1.28, 95% CI, 0.81-2.01, p = 0.29), or OS (HR, 1.62, 95% CI, 0.97-2.69, p = 0.06). Cognitive functions were preserved or improved after ASCT.
CONCLUSIONS: ASCT is a feasible approach for consolidation with good tolerability for newly diagnosed PCNSL patients. High-quality randomized controlled trials are still needed to confirm the effects of ASCT.
BACKGROUND: https://www.crd.york.ac.uk/prospero/, identifier CRD42021268422.