Efficacy and safety of anti-PD-1/PD-L1 antibodies in patients with relapsed refractory diffuse large B-cell lymphoma: A meta-analysis

Abstract

This article conducts a meta-analysis to evaluate the safety and efficacy of PD-1/PD-L1 inhibitors in patients with relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL). A total of 63 papers were initially retrieved, and eight clinical studies were collected. The estimated effect of ORR was [OR = 0.40, 95% CI 0.29-0.51; p = 0.08], the estimated effect of complete response rate was [OR = 0.21, 95% CI 0.14-0.31; p < 0.001], while the estimated effect of 1-year progression-free survival was [OR = 0.33, 95% CI 0.22-0.47; p = 0.01]. The estimated effect of 1-year OS was [OR = 0.67, 95% CI 0.55-0.77; p = 0.05]. In addition, the estimated effect of grade 3 adverse events was [OR = 0.33, 95% CI 0.22-0.46; p = 0.01]. Overall, PD-1/PD-L1 inhibitors demonstrated suboptimal therapeutic efficacy in the selected trials for R/R DLBCL. However, combining PD-1/PD-L1 inhibitors with CAR-T showed potential for improved treatment outcomes. Additionally, PD-1/PD-L1 inhibitors were found to be safe and well-tolerated in patients with R/R DLBCL.

Keywords: PD-1/PD-L1 blockade; immune checkpoint molecule; meta-analysis; relapsed/refractory diffuse large B-cell lymphoma; treatment.

Figure 1

Flow chart of the literature search and study selection.

Figure 2

(a) The forest plot of the level of ORR. The heterogeneity test result was Q = 89.51 (p < 0.001) and I ² = 82%. The estimated effect was [OR = 0.40, 95% CI 0.29–0.51; p = 0.08]. (b) The forest plot of the level of CRR. The heterogeneity test result was Q = 67.76 (p < 0.001) and I ² = 76%. The estimated effect was [OR = 0.21, 95% CI 0.14–0.31; p < 0.001].

Figure 3

(a) The forest plot of the level of 1-year PFS. The heterogeneity test result was Q = 96.64 (p < 0.001) and I ² = 84%. The estimated effect was [OR = 0.33, 95% CI 0.22–0.47; p = 0.01]. (b) The forest plot of the level of 1-year OS. The heterogeneity test result was Q = 68.33 (p < 0.001) and I ² = 81%.The estimated effect was [OR = 0.67, 95% CI 0.55–0.77; p = 0.05].

Figure 4

(a) The forest plot of the level of AEs. The heterogeneity test result was Q = 40.29 (p < 0.001) and I ² = 70%. The estimated effect was [OR = 0.81, 95% CI 0.70–0.89; p＜0.001]. (b) The forest plot of the level of grade 3 AEs. The heterogeneity test result was Q = 49.65 (p < 0.001) and I ² = 78%. The estimated effect was [OR = 0.33, 95% CI 0.22–0.46; p = 0.01].

Figure 5

Subgroup analysis conducted based on whether CAR-T was combined.