■新的抗白血病疗法(抗CD20单克隆抗体,布鲁顿酪氨酸激酶抑制剂,磷酸肌醇3-激酶抑制剂,和B细胞淋巴瘤-2拮抗剂)在复发性/难治性慢性淋巴细胞白血病(CLL)患者的临床试验中,与选定的标准方案相比,改善了无进展生存期(PFS)。不幸的是,所有可能的治疗方案的相对疗效仍然未知,因为没有直接证据支持所有可能的比较.
■我们旨在比较新型药物的疗效和安全性,化疗,和免疫疗法使用贝叶斯网络荟萃分析(NMA)。
■使用贝叶斯NMA进行系统文献综述。
■对复发/难治性CLL的随机临床试验进行了广泛的系统文献综述。我们搜索了医学数据库中索引的文章(MEDLINE,Embase,Cochrane库)和灰色文献,可以进一步实施到贝叶斯NMA中。
■系统搜索确定了15项随机试验,这些试验形成了比较PFS的网络,总生存期(OS),总体反应率,和严重不良事件。我们的研究表明,与标准化学免疫疗法和免疫疗法相比,所有包含新型药物的方案均显着延长了PFS。在靶向药物中,维奈托克(VEN)+利妥昔单抗(RTX)在PFS方面的疗效与扎努鲁替尼(ZAN)相当[风险比(95%可信区间),1.10(0.59-2.08)],阿卡拉布替尼(ACA)[0.78(0.47-1.30)],依鲁替尼(IBR)单药治疗[0.72(0.41-1.27)],和其他基于IBR的方案。ZAN优于IBR单药治疗[0.65(0.49-0.86)],但不优于ACA[0.71(0.49-1.02)]。在上述任何比较中,OS没有显著差异。
■所有新疗法都比化学免疫疗法和免疫疗法具有更好的疗效。在新特工中,VEN+RTX的相对疗效与所有BTKi相似,ZAN优于IBR,与ACA相当。
■PROSPEROCRD42022304330。
UNASSIGNED: The recent development of new antileukemic therapies (anti-CD20 monoclonal antibodies, Bruton tyrosine kinase inhbitors, phosphoinositide 3-kinase inhibitors, and B-cell lymyphoma-2 antagonists) improved the progression-free survival (PFS) compared with selected standard regimens in clinical trials for patients with relapsed/refractory chronic lymphocytic leukemia (CLL). Unfortunately, the relative efficacy of all possible therapeutic options remains unknown because there is no direct evidence for all possible comparisons.
UNASSIGNED: We aimed to compare the efficacy and safety of novel agents, chemotherapy, and immunotherapy using a Bayesian network meta-analysis (NMA).
UNASSIGNED: Systematic literature review with Bayesian NMA.
UNASSIGNED: An extensive systematic literature review of randomized clinical trials for relapsed/refractory CLL was performed. We searched for articles indexed in medical databases (MEDLINE, Embase, The Cochrane Library) and gray literature that could be further implemented into the Bayesian NMA.
UNASSIGNED: The systematic search identified 15 randomized trials that formed networks comparing PFS, overall survival (OS), overall response rates, and serious adverse events. Our study showed that all regimens containing novel agents significantly prolonged PFS compared with standard chemoimmunotherapy and immunotherapy. Among targeted drugs, venetoclax (VEN) + rituximab (RTX) had comparable efficacy in terms of PFS to zanubrutinib (ZAN) [hazard ratio (95% credible interval), 1.10 (0.59-2.08)], acalabrutinib (ACA) [0.78 (0.47-1.30)], ibrutinib (IBR) monotherapy [0.72 (0.41-1.27)], and other IBR-based regimens. ZAN was superior to IBR monotherapy [0.65 (0.49-0.86)] but not to ACA [0.71 (0.49-1.02)]. There were no significant differences in OS in any of the above comparisons.
UNASSIGNED: All novel therapies have better efficacy than chemoimmunotherapy and immunotherapy regimens. Among novel agents, the relative efficacy of VEN + RTX was similar to all BTKi, while ZAN was superior to IBR and comparable to ACA.
UNASSIGNED: PROSPERO CRD42022304330.