Study Looks Favorably at Adding Rituximab to Primary Central Nervous System Lymphoma Treatment

A recent study suggests that adding rituximab to a high‐dose methotrexate (HD‐MTX)‐based combination chemotherapy could prolong overall survival (OS) as well as progression-free survival (PFS) for patients with primary central nervous system lymphoma (PCNSL), a rare and aggressive form of lymphoma.

Since 2000, the preferred front‐line treatment for PCNSL has been HD‐MTX, with or without whole‐brain radiotherapy (WBRT), although there is no consensus about the most effective chemotherapy regimen. More frequently, however, rituximab plus combination chemotherapy is being used for these patients, who generally have poor outcomes.

To evaluate the survival benefit of adding rituximab, researchers searched the electronic databases, MEDLINE, EMBASE, COCHRANE, Web of Science, and SCOPUS to retrieve clinical studies; a total of 5 articles were included. Two of them were used to conduct qualitative meta‐analysis. Hazards ratios (HRs) with 95% confidence intervals (CIs) were pooled across studies using a random‐effects model.

The studies compared the OS between rituximab group and the control group. The OS was reported by median months of PFS, HR with 95% CI, or percent of OS for 2 years.

Three of the 5 studies reported overall OS by median month, in which OS was longer in the group with added rituximab than in the control group.

The other 2 studies presented OS as HR with 95% CI; the HRs between the rituximab group and the control group were 0.63 (95% CI, 0.42&#8208;1.02), and 0.73 (95% CI, 0.35&#8208;1.52). The risk of heterogeneity was very low between the 2 studies (Q&#8208;value = .859, P = .354; I2 = 0.000). When the 2 studies were combined with a fixed effect model, the pooling estimate of HR was 0.604 with 95% CI of 0.413 to 0.883 (P <.01).

The meta&#8208;analysis on PFS suggests that there was no significant heterogeneity between the studies, the authors said.

Reference

Lee W, Go S, Kwon O. The role of rituximab in primary central nervous system lymphoma (PCNSL): A systematic review and meta&#8208;analysis. Presented at: 15th International Conference on Malignant Lymphoma Palazzo dei Congressi, June 18-22, 2019; Lugano, Switzerland. Abstract 424.