Efficacy and safety of front-line treatment regimens for Waldenstrom macroglobulinaemia: a systematic review and meta-analysis.
Wee-Lee ChanVanessa Cui Lian ChongIan Jun Yan WeeLi Mei PoonEsther Hian Lee ChanJoanne LeeYen-Lin CheeAnand D JeyasekharanWee-Joo ChngMiny SamuelSanjay De MelPublished in: Blood cancer journal (2023)
Rituximab-based chemo-immunotherapy is currently the standard first-line treatment for Waldenstrom macroglobulinaemia (WM), while ibrutinib has emerged as an alternative. In the absence of randomised trials (RCTs) comparing these regimens, the optimal first-line treatment for WM remains uncertain. In this systematic review and meta-analysis, we sought to assess the efficacy and safety of first-line treatment regimens for WM. We searched key databases from January 2007 to March 2023, including phase II and III trials, including treatment-naïve WM patients treated with rituximab-based regimens or ibrutinib. Response rates, progression-free survival (PFS), overall survival (OS), and toxicities were evaluated. Four phase III and seven phase II trials were included among 736 unique records. Pooled response rates from all comparative and non-comparative trials were 46%, 33% and 26% for bendamustine rituximab (BR), bortezomib-dexamethasone, cyclophosphamide, rituximab (BDRC) and ibrutinib rituximab (IR), respectively. Two-year pooled PFS was 89%, 81% and 82% with BR, BDRC and IR, respectively. Neuropathy was more frequent with bortezomib, while haematologic and cardiac toxicities were more common with chemo-immunotherapy and ibrutinib-based regimens respectively. Our findings suggest that BR yields higher response rates than bortezomib or ibrutinib-based combinations. RCTs comparing BR against emerging therapies, including novel Bruton Tyrosine Kinase Inhibitors, are warranted.
Keyphrases
- chronic lymphocytic leukemia
- phase ii
- phase iii
- open label
- clinical trial
- free survival
- placebo controlled
- double blind
- multiple myeloma
- diffuse large b cell lymphoma
- photodynamic therapy
- combination therapy
- low dose
- study protocol
- left ventricular
- squamous cell carcinoma
- newly diagnosed
- deep learning
- cancer therapy
- artificial intelligence
- radiation therapy