Meta-analysis Supports Maintenance Therapy for Reducing CLL Progression
Posted: Monday, April 6, 2020
According to a network meta-analysis published in PLOS ONE, the administration of maintenance therapies such as lenalidomide, rituximab, and ofatumumab in patients with chronic lymphocytic leukemia (CLL) result in longer progression-free survival than abstention from intervention. In addition, lenalidomide was found to be the most effective of the tested maintenance therapies. However, no real difference in terms of overall survival was observed with maintenance therapy compared with no intervention.
“Based on the present evidence, maintenance therapy may [be] considered in CLL patients who have achieved at least partial response following previous therapy,” concluded Cho-Hao Lee, MD, of the National Defense Medical Center in Taiwan, and colleagues.
The meta-analysis reviewed six randomized controlled trials that involved the maintenance therapies lenalidomide, rituximab, ofatumumab, ibrutinib, idelalisib, venetoclax, and obinutuzumab. A total of 1,615 patients with CLL were included.
Of the tested therapies, lenalidomide, rituximab, and ofatumumab resulted in the longest progression-free survival versus no intervention (hazard ratio [HR] = 0.37, 95% confidence interval [CI] = 0.27–0.50; HR = 0.50, 95% CI = 0.38–0.66; HR = 0.52, 95% CI = 0.41–0.66, respectively), with lenalidomide achieving the greatest efficacy in curbing disease progression (HR = 0.37, 95% CI = 0.27–0.50). However, maintenance therapy did not show superiority versus no intervention in regard to overall survival (HR = 0.89, 95% CI = 0.70–1.14).
The meta-analysis included literature through March 6, 2019, in the PubMed, Embase, and Cochrane databases. Abstracts and articles from major oncology meetings in 2018 were included.
“In the absence of direct head-to-head comparison trials to compare different maintenance therapies, [network meta-analysis] could provide useful estimates for the relative efficacy and safety of maintenance therapies in CLL,” the authors concluded.
Disclosure: The study authors reported no conflicts of interest.
