The role of bortezomib in newly diagnosed diffuse large B cell lymphoma: a meta-analysis

Lin, Zhijuan; Chen, Xing; Li, Zhifeng; Zhou, Yong; Fang, Zhihong; Luo, Yiming; Zhao, Jiang; Xu, Bing

doi:10.1007/s00277-018-3435-1

Cited by 12 publications

(10 citation statements)

References 20 publications

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“…Initial R-CVP and bendamustine-based regimens have been utilized in older patients [59][60][61]. Trials adding bortezomib to an R-CHOP backbone in adults of all ages have not revealed improved efficacy [23,62,63]. Lenalidomide has also been added to R-CHOP, as well as used as maintenance therapy in responding patients, with promising results [29,64,65].…”

Section: Discussionmentioning

confidence: 99%

Treatment approaches for older and oldest patients with diffuse large B-cell lymphoma – Use of non-R-CHOP alternative therapies and impact of comorbidities on treatment choices and outcome: A Humedica database retrospective cohort analysis, 2007–2015

Morrison

Hamilton²,

Ogbonnaya³

et al. 2020

Journal of Geriatric Oncology

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a b s t r a c tIntroduction: We characterized real-world treatment patterns in older (65-74 years) and oldest (75-85 years) patients with diffuse large B-cell lymphoma (DLBCL) receiving initial therapy (R-CHOP, non-R-CHOP regimens). Impact of comorbidities on treatment choice, and overall and progression-free survival (OS, PFS) were assessed by age. Patients and Methods: Using the Humedica database, we identified 1436 newly diagnosed patients with DLBCL who received frontline therapy from 1/07-9/15. The 885 patients ≥65 years of age were further evaluated for baseline demographics, comorbidities, initial therapy, and PFS/OS. Results: Of 885 patients, 406 (45.9%) were age 65-74, and 479 (54.1%) age 75-85, years. First line therapy was R-CHOP (61.8%) or non-R-CHOP (38.2%). Although Charlson Comorbidity Index (CCI) scores were similar at baseline, congestive heart failure and myocardial infarction were more common in those receiving non-R-CHOP regimens. Survival outcomes were superior for those receiving initial R-CHOP, versus non-R-CHOP, therapy (median PFS 53.9 versus 27.8 months; two-year PFS 71.2% versus 51.6%, p b .0001; median OS not reached versus 45 months; two-year OS 81.3% versus 62.9%, p b .0001, respectively). Only 10.4% (R-CHOP) and 12.1% (non-R-CHOP) of patients received second line therapies. Two-year OS by age (65-74, 75-85 years) was 66.4% and 39.1%, respectively with R-CHOP (p = .0045), and 74.3% and 54.5%, respectively with non-R-CHOP (p = .004), therapy. Age ≥ 75 years and CCI of 2+ were associated with shorter OS and PFS. Conclusions: This study identified real-world first line treatment patterns for older patients with DLBCL. Our findings support the feasibility of administering standard R-CHOP therapy, even to oldest patients with DLBCL.

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Section: Discussionmentioning

confidence: 99%

Treatment approaches for older and oldest patients with diffuse large B-cell lymphoma – Use of non-R-CHOP alternative therapies and impact of comorbidities on treatment choices and outcome: A Humedica database retrospective cohort analysis, 2007–2015

Morrison

Hamilton²,

Ogbonnaya³

et al. 2020

Journal of Geriatric Oncology

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“…This is the first meta-analysis to compare various targeted therapies for patients with DLBCL, whereas several other meta-analysis have provided the results for a single agent. A meta-analysis conducted by Lin et al contained four studies and found that bortezomib-containing regimens did not yield significant improvements in survival outcomes, and might be associated with a greater risk of peripheral neuropathy compared to standard R-CHOP regimens [ 40 ]. Moreover, Ren et al observed that rituximab salvage therapy was associated with better OS, PFS, and ORR for relapse or refractory DLBCL, whereas maintenance rituximab therapy did not significantly affect OS or EFS [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Network meta-analysis of targeted therapies for diffuse large B cell lymphoma

2020

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Background The purpose of this network meta-analysis of randomized controlled trials (RCTs) was to compare rank targeted therapies for patients with diffuse large B-cell lymphoma (DLBCL). Methods The PubMed, EmBase, and Cochrane library electronic databases were systematically searched throughout December 2019. Direct and indirect evidence from relevant RCTs was identified for network meta-analysis. The pooled results for grade 3 or greater adverse events between targeted therapies and chemotherapy were calculated using a random-effects model. Results A total of 18 RCTs enrolling 8207 DLBCL patients were selected for the final meta-analysis. The results of the network analysis indicated that the addition of dacetuzumab (74.8%) to rituximab-based regimens or lenalidomide (77.1%) was associated with better therapeutic effects on overall survival, whereas dacetuzumab (80.4%) or bortezomib (70.8%) added to rituximab was most likely to improve events-free survival. Moreover, lenalidomide (93.8%) and I-tositumomab (77.2%) were associated with higher overall response rates. Finally, patients receiving targeted therapies were associated with an increased risk of diarrhea (RR: 2.63; 95%CI: 1.18–5.86; P = 0.019), and thrombocytopenia (RR: 1.41; 95%CI: 1.05–1.90; P = 0.023). Conclusions This study provides the best treatment strategy for DLBCL patients in terms of overall survival, events-free survival, and overall response rate. The findings of this study require validation with further large-scale RCTs.

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“…Intrathecal chemotherapy can also be used in conjunction with these regimens as prophylaxis against lymphoma affecting the central nervous system due to HIV status, which increases the central nervous system (CNS) risk [ 8 ]. Sparse published literature examining the impact of adding bortezomib to CHOP or EPOCH therapy in DLBCL patients has yielded mixed results [ 9 - 10 ]. A 2009 study demonstrated that R-CHOP with bortezomib resulted in an overall >75% CR rate in various types of B-cell lymphoma, with an 88% CR rate in patients with aggressive lymphoma such as DLBCL [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…A 2009 study demonstrated that R-CHOP with bortezomib resulted in an overall >75% CR rate in various types of B-cell lymphoma, with an 88% CR rate in patients with aggressive lymphoma such as DLBCL [ 9 ]. In contrast, in 2018, the first meta-analysis on the efficacy of bortezomib containing regimens in DLBCL patients undertaken concluded that adding bortezomib does not improve the overall survival rate in patients newly diagnosed with DLBCL or the ABC DLBCL subtype, which is the most common variation [ 10 ]. Bortezomib is classically used to treat multiple myeloma and mantle cell lymphoma.…”

Section: Discussionmentioning

confidence: 99%

An Advanced AIDS Patient With CD4 <20 and Plasmablastic Lymphoma Achieving Complete Response With the V-EPOCH Regimen

Nelson

Hong

Iqbal

et al. 2020

Cureus

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Plasmablastic lymphoma (PBL) is a rare form of non-Hodgkin lymphoma that is highly aggressive and carries a poor prognosis. Although the standard chemotherapy choice for most diffuse large B-cell lymphomas (DLBCL) is R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone), subtypes of DLBCL such as PBL are less responsive to this treatment regimen. The preferred regimens for PBL include infusional EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin hydrochloride), HyperCVAD (cyclophosphamide, vincristine sulfate, doxorubicin hydrochloride, and dexamethasone), or CODOX-M/IVAC (cyclophosphamide, vincristine, doxorubicin, high‐dose methotrexate/ifosfamide, etoposide, and high‐dose cytarabine). Recent studies have begun to investigate the addition of other agents to these regimens to improve survival. This case report is about a patient with a history of advanced acquired immunodeficiency syndrome (AIDS) with a cluster of differentiation 4 (CD4) count <20 who had CD20 negative plasmablastic lymphoma and was successfully treated with the combination of bortezomib and dose-adjusted EPOCH (V-EPOCH) and intrathecal chemotherapy, achieving complete response with optimal tolerance. To our knowledge, this is the first case to demonstrate a complete response with V-EPOCH for PBL in advanced AIDS with CD4 <20. We aim to highlight the importance of standardizing effective chemotherapeutic approaches to this cancer entity and augment the effectiveness of V-EPOCH therapy in the literature review.

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The role of bortezomib in newly diagnosed diffuse large B cell lymphoma: a meta-analysis

Cited by 12 publications

References 20 publications

Treatment approaches for older and oldest patients with diffuse large B-cell lymphoma – Use of non-R-CHOP alternative therapies and impact of comorbidities on treatment choices and outcome: A Humedica database retrospective cohort analysis, 2007–2015

Treatment approaches for older and oldest patients with diffuse large B-cell lymphoma – Use of non-R-CHOP alternative therapies and impact of comorbidities on treatment choices and outcome: A Humedica database retrospective cohort analysis, 2007–2015

Network meta-analysis of targeted therapies for diffuse large B cell lymphoma

An Advanced AIDS Patient With CD4 <20 and Plasmablastic Lymphoma Achieving Complete Response With the V-EPOCH Regimen

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