AUTHOR=Zeremski Vanja , Kropf Siegfried , Koehler Michael , Gebauer Niklas , McPhail Ellen D. , Habermann Thomas , Schieppati Francesca , Mougiakakos Dimitrios 

TITLE=Induction treatment in high-grade B-cell lymphoma with a concurrent MYC and BCL2 and/or BCL6 rearrangement: a systematic review and meta-analysis

JOURNAL=Frontiers in Oncology

VOLUME=13

YEAR=2023

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2023.1188478

DOI=10.3389/fonc.2023.1188478

ISSN=2234-943X

ABSTRACT=<sec><title>Background and aim</title><p>High-grade B cell lymphomas with concomitant <italic>MYC</italic> and <italic>BCL2</italic> and/or <italic>BCL6</italic> rearrangements (HGBCL-DH/TH) have a poor prognosis when treated with the standard R-CHOP-like chemoimmunotherapy protocol. Whether this can be improved using intensified regimens is still under debate. However, due to the rarity of HGBCL-DH/TH there are no prospective, randomized controlled trials (RCT) available. Thus, with this systematic review and meta-analysis we attempted to compare survival in HGBCL-DH/TH patients receiving intensified vs. R-CHOP(-like) regimens.</p></sec><sec><title>Methods</title><p>The PubMed and Web of Science databases were searched for original studies reporting on first-line treatment in HGBCL-DH/TH patients from 08/2014 until 04/2022. Studies with only localized stage disease, ≤10 patients, single-arm, non-full peer-reviewed publications, and preclinical studies were excluded. The quality of literature and the risk of bias was assessed using the Methodological Index for Non-Randomized Studies (MINORS) and National Heart, Lung, and Blood Institute (NHLBI) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Random-effect models were used to compare R-CHOP-(like) and intensified regimens regarding 2-year overall survival (2y-OS) and 2-year progression-free survival (2y-PFS).</p></sec><sec><title>Results</title><p>Altogether, 11 retrospective studies, but no RCT, with 891 patients were included. Only four studies were of good quality based on aforementioned criteria. Intensified treatment could improve 2y-OS (hazard ratio [HR]=0.78 [95% confidence interval [CI] 0.63-0.96]; p=0.02) as well as 2y-PFS (HR=0.66 [95% CI 0.44-0.99]; p=0.045).</p></sec><sec><title>Conclusions</title><p>This meta-analysis indicates that intensified regimens could possibly improve 2y-OS and 2y-PFS in HGBCL-DH/TH patients. However, the significance of these results is mainly limited by data quality, data robustness, and its retrospective nature. There is still a need for innovative controlled clinical trials in this difficult to treat patient population.</p></sec><sec><title>Systematic review registration</title><p><uri xlink:href="https://www.crd.york.ac.uk/prospero" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.crd.york.ac.uk/prospero</uri>, identifier CRD42022313234.</p></sec>