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Non-Hodgkin Lymphoma
Impact on survival through consolidation radiotherapy for diffuse large B-cell lymphoma: a comprehensive meta-analysis
Ferrata Storti Foundation
Haematologica 2021 Volume 106(7):1923-1931
Martin D. Berger,1* Sven Trelle,2* Annina E. Büchi,3 Sabrina Jegerlehner,3 Codruta Ionescu,4 Thierry Lamy de la Chapelle5 and Urban Novak1
1Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland; 2CTU Bern, University of Bern, Switzerland; 3Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; 4Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland and 5Hematology Department, Rennes University Hospital, INSERM Research Unit 1236, Rennes, France
*MDB and ST contributed equally as co-first authors.
ABSTRACT
Rituximab has improved response rates and overall survival in dif- fuse large B-cell lymphoma. Radiotherapy is an effective treatment modality for lymphomas, but there is uncertainty on its use as consolidation after chemo-immunotherapy mainly in advanced stages. We evaluated its efficacy with a comprehensive meta-analysis and a sys- tematic search of Pubmed, Embase, Cochrane, and abstracts from the American Society of Clinical Oncology, American Society of Hematology, European Society for Medical Oncology and American Society of Radiation Oncology published from June 1966 and December 2018. We identified 11 trials that evaluated consolidation radiotherapy following chemotherapy in a randomized fashion in 4,584 patients. The primary endpoint of this meta-analysis was progression-free survival (PFS). As three of the 11 trials were retracted, this data is based on 2,414 patients. For the primary endpoint, PFS, we found a hazard ratio (HR) 0.77 (95% Confidence Interval [CI]: 0.51-1.17), pooled (tau2: 0.25; I2: 85%), and a HR 0.80 (95% CI: 0.53-1.21), pooled in a bivariate meta- analysis and for the secondary endpoint, overall survival, a HR 0.93 (range, 0.61-1.40), pooled (tau2: 0.25; I2: 74%) and a HR 0.86 (95% CI: 0.58-1.27) in a bivariate meta-analysis. The lack of benefit did not change over time (P=0.95 (tau2: 0.32; I2: 88%), and was also absent for PFS when stratifying for i) chemotherapy, ii) the use of rituximab, iii) age, iv) the dose of radiotherapy and v) application to patients in complete remission with bulky disease. None of the trials used a positron emission tomog- raphy-guided approach. This meta-analysis revealed no survival benefit when consolidation radiotherapy is given to unselected diffuse large B- cell lymphoma patients following chemotherapy. These results need to be considered in future trials in the positron emission tomography-com- puted tomography era.
Introduction
Comprising 35% of all non-Hodgkin lymphomas (NHL), diffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma in adults. The cur- rent standard therapy rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) cures two-thirds of patients.1,2 Several attempts with a vari- ety of approaches including the addition of new drugs have so far failed to improve these results.3,4 Radiotherapy is an effective treatment option for patients with aggressive lymphomas. It was initially used as a primary modality for various lymphomas and was later used as consolidation when anthracycline-containing regimens became available in the 1980s. Radiotherapy is now commonly used in localized disease.5 As such, consolidation radiotherapy is part of the first line treat-
Correspondence:
URBAN NOVAK
urban.novak@insel.ch
Received: February 9, 2020. Accepted: June 12, 2020. Pre-published: June 18, 2020.
https://doi.org/10.3324/haematol.2020.249680
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haematologica | 2021; 106(7)
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