In European journal of haematology
OBJECTIVE : In chronic lymphocytic leukaemia, growing evidence has accumulated about long-term outcomes of first-line treatments. Our objective was to perform indirect comparisons across first-line treatments.
METHODS : We applied the Shiny method, an artificial intelligence technique that analyses Kaplan-Meier curves and reconstructs patient-level data. Reconstructed patient data were then evaluated through standard survival statistics and indirect head-o-head comparisons. The endpoint was progression-free survival (PFS).
RESULTS : Seven first-line treatments were studied (1,983 patients). Three treatments based on either ibrutinib or venetoclax (i.e. ibrutinib monotherapy, ibrutinib+ rituximab/obinutuzumab and venetoclax+obinutuzumab) showed a very similar survival pattern. The PFS for these 3 treatments was significantly better than that of the remaining 4 treatments (fludarabine+cyclophosphamide+rituximab, chlorambucil+obinutuzumab, bendamustine+rituximab, and chlorambucil monotherapy). Regarding chlorambucil+ obinutuzumab, a significant between-trial variability was found.
CONCLUSIONS : Long-term results are particularly favorable to ibrutinib (alone or in combination) and discourage further use of chlorambucil. As in other studies based on the Shiny method, the multi-treatment Kaplan-Meier graph summarized the available evidence in comparative terms. The evidence generated this way contributes to define the place in therapy of individual agents.
Messori Andrea
2022-Oct-03
chlorambucil, chronic lymphocytic leukaemia, cyclophosphamide rituximab, fludarabine, ibrutinib, obinutuzumab, progression-free survival, rituximab, venetoclax
