Eficácia dos regimes de salvamento dose intensificado versus dose padrão na sobrevida livre de progressão em pacientes com linfoma folicular recidivado precoce ou refratário submetidos ao transplante autólogo de células tronco hematopoiéticas: uma revisão sistemática e meta-análise

Abstract

Despite substantial advancements in managing follicular lymphoma, approximately 20% of these patients experience disease progression within 2 years after induction therapy. These patients exhibit poorer outcomes, and it has been proposed that autologous bone marrow transplantation could enhance survival in this context. Little is known about the ideal rescue chemotherapy regimen. OBJECTIVE: To evaluate the efficacy of dose-intensified rescue regimens compared to standard dose chemotherapies in progression free survival among adult patients diagnosed with early relapsed or primary refractory follicular lymphoma before proceeding to high dose chemotherapy followed by autologous bone marrow transplantation. METHODS: This study is in accordance with the Joanna Briggs Institute (JBI) methodology for effectiveness systematic review and metanalysis. The search strategy was structured based on the PICO question and tailored to databases including Medline, Embase, Scopus, Web of Science, Lilacs and Cochrane Library. The literature search was conducted on May 19, 2023, with no restrictions on publication date or language. Case reports, case series, review articles and conference presentations were excluded to ensure data homogeneity. Initially, studies were screened by title and abstracts. Those potentially relevant were read in full and assessed against inclusion criteria. Finally, articles deemed eligible had their data extracted if they reached a minimum score of 50% in agreement with the JBI Cohort Critical Appraisal Tool for quality assessment. We used the Cochrane Risk of Bias for Non Randomized Studies (ROBINS-I) tool in our analysis. The entire process involved two different researchers, and a third, more experienced researcher was consulted to resolve any disagreements. This study protocol is registered on the PROSPERO platform under registration number CRD42022373345. The study selection flowchart is in accordance with the PRISMA 2020 guideline. RESULTS: A total of 494 articles were identified on the subject. Following removal of 128 duplicates, 366 studies underwent title and abstract screening. Of these, 24 papers were selected for full-text review. Among the 342 excluded studies, the primary reasons included study design, population not exclusively comprising follicular lymphoma patients, and inclusion of treatment-naïve patients. Upon application of inclusion and exclusion criteria, 02 studies were included. A proportional meta-analysis of overall response rate outcome was conducted. Data synthesis show a low degree of heterogeneity using the standard chi-squared test (χ2 = p > 0,05) and the I-squared test (I2 = 0%), denoting robustness and precision. Using the GRADE approach, our data suggest that dose intensified salvage regimens are a feasible option with a low certainty of evidence.