Effectiveness of dose-intensified regimens in early progressed follicular lymphoma before autologous stem cell transplantation: A systematic review and meta-analysis

Introduction: Despite the substantial advances in the management of follicular lymphoma, approximately 20% of these patients have worse outcomes, experiencing early progression of the disease after induction therapy. Autologous stem cell transplantation may improve survival in this context. Little is known about the optimal salvage regimen. Purpose: To evaluate the effectiveness of dose-intensified versus standard-dose salvage regimen in adult patients diagnosed with early progressed follicular lymphoma before autologous stem cell transplantation. Methods: This systematic review and meta-analysis adhere to the Joanna Briggs Institute methodology for systematic reviews of effectiveness and Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched Medline, Embase, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature (LILACS), Cochrane Library databases and gray literature for eligible studies. Results: In total, 494 studies were considered for title and abstract screening. After full review, two studies were eligible for data extraction. Both studies were single arm retrospective cohorts with patients receiving dose-intensified regimens as salvage regimen. Due to missing values, we could not perform a pooled analysis of time-dependent outcomes. We performed a proportional meta-analysis for overall response rate. An odds ratio of 0.93 (95% confidence interval 0.81–0.97) was demonstrated using the random-effects model. Data synthesis showed a low degree of heterogeneity. Conclusion: Using the GRADE approach, our data suggested that dose-intensified salvage regimens are a feasible option with low certainty of evidence, due to serious risk of bias and serious indirectness.