利妥昔单抗治疗原发中枢神经系统淋巴瘤的Meta分析

Rituximab in treatment of primary central nervous system lymphoma:A meta analysis

目的通过系统性分析来评价利妥昔单抗治疗初发原发中枢系统淋巴瘤(PCNSL)的缓解情况与生存预后.方法通过检索数据库查找文献,利用RevMan 5.3软件对含或不含利妥昔单抗治疗方案的疾病缓解情况和生存结局进行分析.结果含利妥昔单抗组较不含利妥昔单抗组的完全缓解率(OR=1.82,95%CI 1.40~2.37)、2年无进展生存率(OR=2.21,95%CI 1.29~3.77)及总体生存率(OR=1.75,95%CI 1.33~2.30)、5年无进展生存率(OR=1.98,95%CI 1.43~2.74)及总体生存率(OR=2.07,95%CI 1.52~2.82)有优势.同时两组之间血液毒性、感染风险、神经系统毒性、肝肾功能损害等方面的不良反应,差异均无统计学意义(OR分别=1.35、0.89、1.41、0.85、0.89、0.80、1.14,P均>0.05).结论利妥昔单抗能提高PCNSL的疾病缓解率,改善PCNSL患者的生存预后,同时不会增加不良反应的发生率.

Objective To analyze the remission and survival prognosis of rituximab in the treatment of primary central system lymphoma(PCNSL)by systematic analysis.Method Such databases as CNKI,WanFang,PubMed,Medline,Embase,Cochrane library,CBM and VIP were searched to collect the literature.Meta-analysis was performed using RevMan5.3 to analyze the remission and survival prognosis of rituximab in the treatment of PCNSL. Results The rituximab group is significantly better than non-rituximab group in complete remission(OR=1.82,95% CI 1.40~2.37),2-year progression-free survival(OR=2.21,95% CI 1.29~3.77)and overall survival(OR=1.75,95% CI 1.33~2.30),and 5-year progression-free survival(OR=1.98,95% CI 1.43~2.74)and overall survival(OR=2.07,95% CI 1.52~2.82).There was no significant differences in the adverse effects of hematological toxicity,infection,neurotoxicity,hepatic toxicity and nephrotoxicity between the two groups(OR=1.35,0.89,1.41,0.85,0.89,0.80,1.14,P>0.05). Conclusion Therapeutic strategies including rituximab can improve remission rate and survival prognosis of PCNSL patients,without increasing the incidence of adverse reactions.