Efficacy And Safety Of B Cell Receptor Signaling Pathway Inhibitors In Chronic Lymphocytic Leukemia:A Meta-analysis

Objective:This meta-analysis was conducted to evaluate the efficacy and safety of B-cell receptor signaling pathway inhibitors in the application of chronic lymphocytic leukemia and provide reliable basis for clinical treatment.Methods:The computer retrieves Pubmed,Embase and The Cochrane Libary database,and the retrieval time is from 2000 to February 2018.Randomized controlled trials involving all BCR signaling pathway inhibitors ibrutinib and idelalisib single drug or their combined drug regimen for chronic lymphocytic leukemia were included according to the inclusion and exclusion criteriaes.Data extraction and bias risk assessment were carried out for standard literatures.The observation indexes were statistically treated by Rev Man5.3 software.The indicators included the rate of progression-free survival at 6months,the overall survival rate at 1 year,the complete response rate and the recurrence rate of fatal adverse events.Results:A total of 6 related literatures were included.There are 3 eligible articles of ibrutinib.The results of meta analysis are as follows:(1)The rate of progression-free survival at 6 months in BCR signaling pathway inhibitor group was 89.8% which higher than in the control group(58.8%)in the treatment of relapsed or refractory CLL patients [RR=1.65,95%CI(1.09,2.49),P<0.05].(2)Compared with the control group,the BCR signaling pathway inhibitor group could improve the overall survival rate at 1 year of patients with relapsed or refractory CLL[RR=1.13,95%CI(1.05,1.21),P<0.05].(3)The complete response rate of CLL patients treated with BCR signal pathway inhibitor group was higher than that in the control group [RR=3.68,95%CI(1.92,7.06),P<0.05].(4)In the case of relapsed or refractory CLL patients,the recurrence rate of fatal adverse events were similar in the BCR signaling pathway inhibitor group and the control group [RR=1.27,95%CI(0.89,1.81),P>0.05].Conclusion:Combined treatment with BCR signaling pathway inhibitors can improve the complete response rate in patients with CLL.In the case of relapsed or refractory CLL patients,the treatment regimen with BCR signaling pathway inhibitors can improve the rate of progression-free survival at 6 months and the overall survival rate at 1 year.The results did not show that the treatment regimen containing BCR signal pathway inhibitors could affect the recurrence rate of fatal adverse events in patients with relapsed or refractory CLL patients.BCR signaling pathway inhibitors provide a new option for clinical treatment of CLL.Because the number of randomized controlled trial included is small,the sample size is small,some documents are of limited quality,further research is needed to better guide clinical treatment.