AUTHOR=Wang Yangyang , Ren Xiyang , Huang Keke , Liang Xue , Pu Lianfang , Hu Linhui , Zhai Zhimin 

TITLE=Comparison of first-line treatments for elderly patients with diffuse large B-cell lymphoma: A systematic review and network meta-analysis

JOURNAL=Frontiers in Immunology

VOLUME=Volume 13 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2022.1082293

DOI=10.3389/fimmu.2022.1082293

ISSN=1664-3224

ABSTRACT=Methods: A systemic review and network meta-analysis of randomized controlled trials were performed by comparing the efficacy and safety of all the regimens as first line treatment for the elderly with DLBCL. We searched PubMed, Cochrane Library, and Embase Library proceedings up to March 2022.
Results: Our search yielded thirteen trials including 1839 patients. R2CHOP21 showed the best PFS with statistically difference and the most favorable OS without statistically difference. RCOMP showed the most clinical benefits in EFS, CR and OR with no significant difference. The point estimate was in favor of improved DFS with RCHOP14 than RCHOP21, although this was not statistically significant. Subgroup analysis concerning 3-4 grade AEs revealed R-COMP was associated with a decrease in grade III/IV neutropenia and cardiac toxic events; RminiCEOP was related to the lower rates of 3 to 4 grade anemia, thrombocytopenia and infection; RCHOP21 exhibited the lowest rate in 3 to 4 grade AE of neurotoxicity. 
Conclusion: The findings of our meta-analysis indicated that R2CHOP21 provided the best disease control in PFS and represented an optimal first-line treatment option in the elderly with DLBCL. Furthermore, the substitution of doxorubicin with Myocet® or epirubicin in RCHOP21 exhibited lower rates in 3-4 grade AEs and might be reasonable treatment options in the elderly when they cannot tolerate RCHOP.