Maintenance therapy for untreated diffuse large B-cell lymphoma: a systematic review and network meta-analysis

Ting Yuan, Feng Zhang, Qingmin Yao, Yanxia Liu, Xiaojuan Zhu, Peng Chen, Ting Yuan, Feng Zhang, Qingmin Yao, Yanxia Liu, Xiaojuan Zhu, Peng Chen

Abstract

Background: Several clinical trials have been conducted to evaluate the role of maintenance therapy in untreated diffuse large B-cell lymphoma (DLBCL) patients with complete response or partial response following standard immunochemotherapy; however, the effect of maintenance therapy remains uncertain, and a suitable maintenance strategy has not been determined because of the lack of direct/indirect comparisons.

Methods: We performed a systematic review and Bayesian network meta-analysis (NMA) to analyze and compare the effectiveness of different maintenance regimens in newly diagnosed DLBCL patients. We searched the PubMed Medline, Embase, Web of Science, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials for relevant papers from inception to 18 March 2021. Our study was prospectively registered in the International Prospective Register of Systematic Reviews (CRD42020168864). Data on overall survival (OS) were extracted and the treatments were ranked using the surface under the cumulative ranking (SUCRA) curve.

Results: Eight trials and seven treatments involving 3525 patients were analyzed. OS analysis indicated that none of the drugs showed any benefit compared with non-maintenance therapy. Maintenance therapy with lenalidomide (SUCRA 69.3%) was ranked first in terms of OS.

Conclusion: Based on the OS results observed in this NMA, we do not recommend maintenance therapy in patients with newly diagnosed DLBLC after first-line therapy.

Keywords: chemotherapy; diffuse large B-cell lymphoma; maintenance therapy; meta-analysis; targeted therapy.

Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

© The Author(s), 2021.

Figures

Figure 1.
Figure 1.
Literature search and selection. Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) flow chart of the study selection for the network meta-analysis. RCT, randomized controlled trial.
Figure 2.
Figure 2.
Network plot of all eligible trials assessing maintenance treatments for untreated diffuse large B-cell lymphoma. The size of each plot represents the number of patients (in brackets) receiving the corresponding intervention. The width of each line represents the number of trials (beside the line) of corresponding comparison.
Figure 3.
Figure 3.
Assessment of the risk of bias in the included studies. +, low risk of bias; −, high risk of bias.
Figure 4.
Figure 4.
Forest plot of network meta-analysis results for overall survival. SUCRA represents the rank probabilities of all included treatments; it equals 1 if the treatment is certain to be ranked the first and 0 if it is certain to be the last. CI, confidence interval; HR, hazard ratio; SUCRA, surface under the cumulative ranking curve.

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