Efficacy And Adverse Effect Of Lenalidomide In Diffuse Large B-cell Lymphoma Patients:a Meta-analysis

Objective:To systematically evaluate the efficacy and safety of lenalidomide in diffuse large B-cell lymphoma patients.Methods:From the date of databases inception to January 2020,English databases,such as PubMed,Web of Science database,as well as Chinese databases,such as China National Knowledge Infrastructure(CNKI),Wan-fang Date,Wei-pu Date were searched to identify research literatures of the clinical trials of lenalidomide in treatment to diffuse large B-cell lymphoma patients,including combined chemotherapy containing lenalidomide and maintenance treatment with lenalidomide.Two researchers independently screened the literatures according to the inclusion and exclusion criteria of the literatures set in this study,and evaluated the quality of the included literatures and extracted the materials.Efficacy and adverse effect of lenalidomide in diffuse large B-cell lymphoma patients were Meta analyzed with Revman 5.3 software.Results:Through literature screening,a total of 9 cohort studies met the incusion criteria in this study.There were three studies on lenalidomide combined with rituximab,three on lenalidomide combined with R-CHOP,and fore on lenalidomide maintenance therapy.① Meta-analysis of the efficacy of lenalidomide in diffuse large Bcell lymphoma patients showed that,total response rate and complete response rate for combined chemotherapy with lenalidomide were 68%(95%CI:48%∽87%,I2=96%)and 57%(95%CI:34%∽80%)I2=94%)respectively.The total and complete response rates were 36%(95%CI:24%∽47%,I2=0)and 28%(95%CI:18%∽39%,I2=0)in the lenalidomide plus rituximab group,97%(95%CI:93%∽100%,I2=34%)and 83%(95%CI:76%∽ 89%,I2=0)in the lenalidomide plus R-CHOP group,respectively.In group of lenalidomide plus R-CHOP group,two years progression free survival was 70%(95%CI:49%∽90%,I2=83%),two years overall survival rate was 85%(95%CI:72%∽99%,I2=78%).Subtype analysis,two years progress free survival rates were 63%(95%CI:50%∽77%,I2=0)and 71%(95%CI:57%∽85%,I2=53%),two years overall survival was 81%(95%CI:70%∽ 92%,I2=27%)和 90%(95%CI:81%∽ 99%,I2=18%)in GCB subtype and non-GCB subtype.②Meta-analysis on the incidence rate of adverse reactions of lenalidomide in diffuse large B-cell lymphoma patients showed that,the incidence of grade 3 and 4 neutropenia was 44%(95%CI:17%∽ 70%,I2=95%),including 39%(95%CI:28%∽51%,I2=51%)in the lenalidomide plus rituximab group and 49%(95%CI:6%∽ 93%,I2=97%)in the lenalidomide plus R-CHOP group.The incidence of grade 3 and 4 thrombocytopenia was 21%(95%CI:9%∽32%,I2=78%),including 19%(95%CI:10%∽28%,I2=49%)in the lenalidomide plus rituximab group and 22%(95%CI:1%∽42%,I2=90%)in the lenalidomide plus R-CHOP group.③In the lenalidomide maintenance regimen,the one year progression free survival ratewas 77%(95%CI:64%∽91%,I2=85%).While,with lenalidomide dose of 25 mg/d was 84%(95%CI:73%∽95%,I2=80%).Therefore,if the patients is well tolerated,the dose of 25mg/d regimen can be used.The two years progression free survival rate and the overall survival rate were 80%(95%CI:76%∽85%,I2=0)和 87%(95%CI:83%∽ 90%,I2=0)respectively.The incidence of grade 3 and 4 neutropenia was 45%(95%CI:22%∽0.68%,I2=92%).Conclusions:1.For diffuse large B-cell lymphoma patients,combined chemotherapy containing lenalidomide is an effective treatment regimen,and the rate of remission of the combination of lenalidomide and R-CHOP is significantly higher than that of the combination of lenalidomide and rituximab.2.Lenalidomide can improve the poor prognosis of non-GCB diffuse large B-cell lymphoma patients.3.Diffuse large B-cell lymphoma patients are well tolerated to lenalidomide in combination with chemotherapy.The most common hematological toxicity is neutropenia and thrombocytopenia.4.Lenalidomide maintenance therapy can improve the prognosis of diffuse large B-cell lymphoma patients with controlled adverse reactions.5.Combined chemotherapy containing lenalidomide is an ideal regimen for the patients of diffuse large B-cell lymphoma,and lenalidomide can be used as a maintenance treatment option for diffuse large B-cell lymphoma.6.This meta-analysis made a systematic analysis with combined chemotherapy containing lenalidomide on the treatment of diffuse large B-cell lymphoma patients,providing evidence-based evidence for the application of lenalidomide to diffuse large B-cell lymphoma patients.