A Systematic Review Of The Efficacy And Safety Of Lenalidomide Combined With R-CHOP In The Treatment Of Newly Diagnosed Diffuse Large B-cell Lymphoma

Objective:Lenalidomide plays an important role in anti-tumor,anti-angiogenesis and immune regulation.This study aims to systematically evaluate the efficacy and safety of lenalidomide combined with R-CHOP(rituximab combined with cyclophosphamide,doxorubicin,vincristine,and prednisone)in the treatment of newly diagnosed diffuse large B-cell lymphoma.Methods:Search for lenalidomide combined with R-CHOP in the treatment of newly diagnosed diffuse large B-cell lymphoma and R-CHOP in the treatment of newly diagnosed diffuse large B-cell lymphoma from the establishment of the database to February 2021 in the English databases of Pubmed,the Cochrane Library,EMBase,CNKI,and Wanfang Date.The search results are not restricted by geographical area and ethnicity,and the literature data that matches the research theme are extracted and systematically evaluated by Stata 15.1software.Observation indicators include overall response rate(ORR),complete remission rate(CR),2-year progression-free survival(PFS),overall survival(OS),and the incidence of ≥3 grade adverse events(AE).Result:A total of 31 studies were included,including 7 in the R2-CHOP group and 24 in the R-CHOP group.The effectiveness results showed: the total response rate of R2-CHOP group and R-CHOP group was 92% [95%CI: 87%-97%] and 88% [95%CI: 86%-91%];complete remission The rates were 75% [95%CI: 70%-81%] and 66% [95%CI: 62%-70%];2-year progression-free survival was 69% [95%CI: 63%-76%] and 73%[95%CI: 69%-76%],the combination rate of GCB group and non-GCB combination in R2-CHOP group was65%[95%CI:46%-84%] and 68%[95%CI:60%-76%];2-year overall survival was 81%[95%CI: 73%-88%] and 82%[95%CI: 80%-85%].The results of the subgroup analysis of the 15 mg lenalidomide group and the 25 mg lenalidomide group showed that the ORR of the15 mg lenalidomide group and the 25 mg group were 86% [95%CI: 76%-96%] and97%[95%CI: 95%-100%],CR were 74%[95%CI: 63%-84%] and 76%[95%CI: 69%-82%],PFS were 73%[ 95%CI: 60%-85%] and 66%[95%CI: 55%-78%].The safety results showed that the most common hematological adverse reactions of grade ≥3 in the R2-CHOP group and R-CHOP group were neutropenia(59%vs52%),thrombocytopenia(23%vs6%)and anemia(17%vs9%),the most common non-hematological AEs ≥3 are infections(23%vs18%),gastrointestinal reactions(7%vs5%),neuropathy(5%vs5%),and discontinuation of adverse reactions/ Death(4% vs 5%);subgroup analysis results showed that the most common hematological AEs in the 15 mg and 25 mg lenalidomide groups were neutropenia(49% vs 62%)and thrombocytopenia(17%vs31%)and anemia(16%vs17%).The most common nonhematological AEs ≥3 are infections(28%vs24%),gastrointestinal reactions(11%vs5%),adverse drug withdrawal/death(1%vs5%).Conclusion:The efficacy of R2-CHOP was superior to the standard R-CHOP regimen in the treatment of primary diffuse large B-cell lymphoma and was not as safe as that of the R-CHOP group,but patients were generally able to tolerate it and could be effectively managed with supportive therapy(transfusion of red blood cells,transfusion of platelets,granulocyte colony-stimulating factor,antibiotic prophylaxis)and dose adjustment.Subgroup analysis showed that lenalidomide 25 mg was more effective than lenalidomide 15 mg in patients with tolerable lenalidomide,especially in younger patients.R2-CHOP has a good effect on newly diagnosed non-GCB DLBCL patients,and there is no significant difference between R2-CHOP and 2-year PFS in GCB DLBCL patients,suggesting that R2-CHOP may be a new option for non-GCB DLBCL patients.