A systematic review and meta-analysis of immunochemotherapy with rituximab for B-cell non-Hodgkin's lymphoma

Background. Although some randomized controlled trials had compared the anti-CD20 monoclonal antibody rituximab plus chemotherapy (R-chemo) to chemotherapy alone for B-cell non-Hodgkin's lymphoma, the curative effects of R-chemo were still controversial. A systematic review and meta-analysis was performed to examine the efficacy of using R-chemo compared with the identical chemotherapy alone in the patients with B-cell non-Hodgkin's lymphoma. Material and methods. Medical databases and conference proceedings were searched for randomized controlled trials which compared R-chemo with chemotherapy alone in patients with newly diagnosed or relapsed B-cell non-Hodgkin's lymphoma. Endpoints were overall survival, overall response, disease control, and adverse events. Results. Twelve eligible trials were identified, reporting outcomes of 4 996 patients. Fixed-effects analysis showed overall survival to be superior for R-chemo-treated patients (relative risks [RR], 1.09; 95%confidence interval [CI], 1.06-1.12, p < 0.00001). Superiority was also observed for the patients receiving R-chemo with respect to overall response (RR, 1.17; 95%CI, 1.10-1.25, p < 0.00001), complete response (RR, 1.52; 95%CI, 1.27-1.82, p < 0.00001), and disease control (RR, 1.36; 95%CI, 1.26-1.46, p < 0.00001). R-chemo improved overall survival, overall response and disease control in patients with diffuse large B-cell lymphoma (RR, 1.11, 95%CI: 1.06-1.16, p < 0.0001; RR, 1.09, 95%CI: 1.01-1.19, p = 0.03 and RR, 2.00, 95%CI: 1.59-2.53, p < 0.00001, respectively) and follicular lymphoma (RR, 1.08, 95%CI: 1.04-1.12, p < 0.0001; RR, 1.19, 95%CI: 1.07-1.33, p =0.001 and RR, 2.58, 95%CI: 1.61-4.12, p < 0.0001, respectively). Meanwhile, R-chemo improved overall response in patients with mantle cell lymphoma (RR, 1.22, 95%CI: 1.07-1.40, p =0.004). Conclusion. R-chemo is superior to chemotherapy alone in patients with B-cell non-Hodgkin's lymphoma, especially for diffuse large B-cell lymphoma and follicular lymphoma.