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Review
. 2025 Jul 15;17(7):4867-4878.
doi: 10.62347/GOXN1938. eCollection 2025.

Rituximab plus chemotherapy for pediatric mature B-cell non-Hodgkin's lymphoma: a systematic review and meta-analysis

Xiuli Zhu  1 , Yuqiao Diao  1 , Yan Chen  1
Affiliations
Review

Rituximab plus chemotherapy for pediatric mature B-cell non-Hodgkin's lymphoma: a systematic review and meta-analysis

Xiuli Zhu et al. Am J Transl Res. .

Abstract

Objective: To conduct a systematic review and meta-analysis evaluating the efficacy and safety of rituximab combined with chemotherapy for the treatment of mature B-cell non-Hodgkin's lymphoma (NHL) in children and adolescents.

Methods: A comprehensive search of PubMed, Embase, the Cochrane Library, and Web of Science was performed to identify relevant studies published up to October 2024. Eligible studies included those involving patients aged 0-15 years diagnosed with mature B-cell NHL. Data were extracted on event-free survival (EFS), overall survival (OS), complete remission rate (CRR), adverse events, immune reconstitution (IgG levels), and recurrence rates. Meta-analyses were conducted using RevMan 5.0.

Results: A total of 11 studies comprising 1,522 participants were included. The addition of rituximab to chemotherapy significantly improved EFS (hazard ratio [HR] = 0.40, 95% confidence interval [CI]: 0.36-0.45, P < 0.05) and OS (HR = 0.38, 95% CI: 0.34-0.42, P < 0.05). CRR was also significantly higher in the rituximab group (odds ratio [OR] = 2.72, 95% CI: 1.76-4.21, P < 0.05). However, a higher incidence of adverse effects was observed (OR = OR= 1.92, 95% CI: 1.25-2.94, P < 0.05). There were no significant differences in recurrence rate or IgG levels between groups.

Conclusion: The addition of rituximab to chemotherapy significantly improved EFS, OS, and CRR in children and adolescents with mature B-cell NHL. Despite an increased risk of toxicity, the survival and remission benefits support the use of rituximab in this population.

Keywords: Rituximab treatment; chemotherapy regime; children and adolescents; effectiveness and safety; mature B-cell non-Hodgkin’s lymphoma.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Literature searching diagram.
Figure 2
Figure 2
Risk of bias.
Figure 3
Figure 3
Forest plot showing the event-free survival rates.
Figure 4
Figure 4
Forest plot showing the overall survival rates.
Figure 5
Figure 5
Forest plot showing the complete remission rates.
Figure 6
Figure 6
Forest plot showing the incidence of toxic effects.
Figure 7
Figure 7
Forest plot showing the immune reconstitution results.
Figure 8
Figure 8
Forest plot showing recurrence rates.
Figure 9
Figure 9
Funnel plots. (A) Event-free survival; (B) Overall survival; (C) Complete remission rate; (D) Toxic effects; (E) Immune reconstitution; (F) Recurrence rate.
See this image and copyright information in PMC

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