An Evidence-based Review of Anti-CD20 Antibody-containing Regimens for the Treatment of Patients With Relapsed or Refractory Chronic Lymphocytic Leukemia, Diffuse Large B-cell Lymphoma, or Follicular Lymphoma

Abstract

Combination regimens with anti-CD20 agents might improve the outcomes of patients with relapsed or refractory B-cell malignancies; however, the available comparative clinical evidence is limited. The present review assessed the reported evidence on the efficacy of anti-CD20 monoclonal antibodies combined with chemotherapy for patients with relapsed or refractory chronic lymphocytic leukemia (CLL), follicular lymphoma (FL), or diffuse large B-cell lymphoma (DLBCL), using a rapid evidence assessment approach. MEDLINE, Embase, and the Cochrane Library were searched from January 1, 1997 to July 14, 2017 (English language only). The data identified from randomized controlled trials or single-arm prospective studies are reported as descriptive study summaries, grouped by anti-CD20 agent and outcome (overall response rate, including complete response and partial response; duration of response; survival, including overall survival and progression-free survival). Of 56 included reports, 32 reported on CLL/small lymphocytic lymphoma, 15 on FL, and 11 on DLBCL. Within the study period, 40, 11, and 7 studies evaluated rituximab, ofatumumab, and obinutuzumab, respectively. Substantially more data were available for rituximab-based combination regimens than for either ofatumumab or obinutuzumab. Moreover, substantial heterogeneity was recorded in the study design and backbone chemotherapy. Thus, the available data are inconclusive regarding any potential similarities or differences in efficacy among these anti-CD20 agents for each respective disease. More importantly, only 1 direct comparison among the anti-CD20 agents was identified, emphasizing the need for head-to-head randomized controlled trials of these drugs to inform clinical decision-making for patients with relapsed or refractory B-cell lymphoproliferative disorders.

Keywords: B-cell lymphoproliferative disorders; Non-Hodgkin lymphoma; Obinutuzumab; Ofatumumab; Rituximab.