| Objective:To systematically evaluate the efficacy and safety of programmed death protein-1(PD-1)inhibitor monotherapy in the treatment of relapsed/refractory lymphoma,and to provide evidence for clinical treatment.Methods:A computer search was conducted on studies related to PD-1 inhibitor monotherapy for relapsed/refractory lymphoma in Pubmed,Embase and The Cochrane Library database from establishment to November 2019.Two reviewers independently screened the literature,evaluated the risk of bias and extracted the data in the included studies.Results:There were 19 literatures included,including 13 pieces of Hodgkin lymphoma(HL)and6 pieces of non-Hodgkin lymphoma(NHL).A total of 1302 cases of patients with relapsed/refractory lymphoma,986 cases of HL and 316 cases of NHL,and 1262 cases of patients for efficacy analysis.In addition,19 articles were involved five kinds of PD-1inhibitor,of which 10 pieces nivolumab,pembrolizumab 6 piece,tislelizumab,sintilimab,camrelizumab each 1 piece.The result analysis shows that,in terms of effectiveness,PD-1inhibitor monotherapy overall remission rate(ORR)of the patients,complete remission rate(CRR),6 months progression-free survival rate(PFSR),overall survival rate(OSR),overall relapse rate were 66%(95%CI:59%~74%),27%(95%CI:21%~35%),80%(95%CI:76%~84%),100%(95%CI:97%~100%),35%(95%CI:27%~44%),respectively.The ORR of each pathological group was analyzed in the subgroup,and the results showed that HL group was 77%(95%CI:72%~82%),NHL group 26%(95%CI:15%~43%),T-cell nonHodgkin lymphoma(T-NHL)group 32%(95%CI:21%~49%),B-cell non-Hodgkin lymphoma(B-NHL)group 22%(95%CI:10% ~ 49%).The CRR of each pathological type group was analyzed,and the results showed that the HL group was 33%(95%CI:25%-44%)and the NHL group was 10%(95%CI:5%-21%).In addition,the ORR of the PD-1inhibitor group with different trade names were analyzed,and the results were as follows :tislelizumab group was 87%(95%CI:79%~ 96%),sintilimab group was 80%(95%CI:72%~89%),camrelizumab group was 76%(95%CI:66%~87%),nivolumab group was 65%(95%CI:54%~78%),pembrolizumab group was 50%(95%CI:37%~68%).The relapse rate after single drug treatment was analyzed,and the results showed that CR group to 9%(95%CI:0%~25%),achieve partial remission(PR)group was 45%(95%CI:17%~76%),post-remission transplantation group was 0%(95%CI:0%~10%),no transplant group after remissionwas 37%(95%CI:16%~60%),the HL group was 25%(95%CI:6%~50%),primary mediastinal large B-cell lymphoma(PMBCL)group was 24%(95%CI:0%~70%).In terms of safety,the total incidence of adverse reactions(AEs)and grade 3 or above were 77%(95%CI:70%-85%)and 25%(95%CI:18%-33%),respectively.The total incidence of AEs in PD-1 inhibitor groups with different trade names was analyzed,and the results showed that nivolumab 65%(95%CI:49%~81%),pembrolizumab 76%(95%CI:58% ~ 95%),tislelizumab 93%(95%CI:84% ~ 98%),sintilimab 93%(95%CI:86% ~ 97%),camrelizumab 100%(95%CI:95%~100%).Conclusion:PD-1 inhibitor monotherapy is effective and safe in the treatment of relapsed/refractory lymphoma.Different pathological types have different curative effects.Both ORR and CRR HL were significantly better than NHL.These results suggest that PD-1 inhibitorcan be used as a treatment for relapsed/refractory lymphoma.Remission after PD-1immunotherapy by bridging transplantation can improve the efficacy. |
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