Comparative Safety of Different First-line Treatments for Chronic Lymphocytic Leukemia/small Lymphocytic Lymphoma: A Systematic Review and Network Meta-analysis

Overview

Journal Ann Hematol

Specialty Hematology

Date 2024 Dec 28

PMID 39731600

Authors

Qingyun Liu

Jiaxing Zhao

Yumiao Li

Youchao Jia

Affiliations

Soon will be listed here.

Abstract

The first-line treatment for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) has recently undergone major changes, and targeted therapies have ushered in a new era of CLL/SLL treatment. Scientists in different countries have successively analyzed the efficacy of various drugs, but safety studies are relatively insufficient. Therefore, this systematic evaluation and retrospective meta-analysis was conducted to compare the differences in adverse effects and their incidence among first-line treatment regimens for CLL/SLL. We searched the Cochrane Library, PubMed, Web of Science, and Embase databases, with a cutoff date of December 2023. Frequency-based network meta-analysis was performed using STATA 16.0, and the risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool (RoB2.0). Thirty-seven randomized controlled trials involving 15,557 patients were included, and the results showed that, compared with other regimens, zanubrutinib had a lower probability of causing adverse hematologic effects and a lower probability of causing severe anemia (SUCRAs: 79. 6%), all-grade anemia (SUCRAs: 87.2%), severe thrombocytopenia (SUCRAs: 97.0%), all-grade thrombocytopenia (SUCRAs: 90.6%), severe neutropenia (SUCRAs: 91.8%) and all-grade neutropenia (SUCRAs: 86.6%) than the other regimens. The higher rates of adverse reactions seen with each of the other first-line regimens were not concentrated in any single regimen. The second-generation BTK inhibitors may have a lower probability of causing hematologic adverse reactions. However, its adverse effects in other systems are still noteworthy. The cardiovascular toxicity of venetoclax combination regimens should not be overlooked.

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