Jaber Jaradat1, Mohammad Abuawwad2, Yousef Al-Bojoq1, Monther N. Ramadan1, Abdulqadir J. Nashwan3
1Faculty of Medicine, Mutah University, Al-Karak, 2Kasr Alainy School of Medicine, Cairo University, 3Hamad Medical Corporation, Doha
Objective:
To evaluate the safety and efficacy of ibrutinib in the treatment of Primary central nervous system lymphoma (CNSL). With overall response (OR), complete response (CR), partial response (PR), progression-free survival (PFS), overall survival (OS), and adverse events in scope.
Background:
CNSL is a rare, aggressive non-Hodgkin lymphoma confined to the CNS. Radiation and chemotherapy, particularly high-dose methotrexate (HD-MTX), are effective treatments, nevertheless; the relapse rates remain high, prompting the exploration of novel therapeutic options. Ibrutinib, an irreversible Bruton tyrosine kinase (BTK) inhibitor, has shown promise in various B-cell malignancies, including CNSL.
Design/Methods:
A comprehensive search of the PubMed, Google Scholar, and Scopus databases was conducted. The included studies were prospective and retrospective studies focusing on ibrutinib as monotherapy or in combination with CNSL. Data extraction and quality assessment were independently performed by two reviewers, and statistical analyses were conducted using R version 4.4.0.
Results:
Fourteen studies (eight cohort studies and six clinical trials) involving 784 patients were included. The median age was 61 years, with nearly equal sex distribution. The meta-analysis demonstrated a significant overall effect of ibrutinib on partial response rates in CNSL (RR=0.27, 95% CI: 0.19-0.39; p < 0.0001). Complete response rates also favored ibrutinib (RR=0.56, 95% CI: 0.35-0.88; p = 0.0114). However, overall survival did not show a significant improvement (HR=1.32, 95% CI: 0.28-6.31; p=0.7248).
Conclusions:
Ibrutinib shows promising efficacy in improving partial and complete response rates in CNSL, although its impact on overall survival remains inconclusive. The substantial heterogeneity observed underscores the need for further well-designed studies to confirm these findings and explore the optimal use of ibrutinib in CNSL treatment protocols.
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