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Background <p>Primary central nervous system lymphoma (PCNSL) is a rare and aggressive form of extranodal non-Hodgkin lymphoma, most often a diffuse large B-cell lymphoma. Rituximab, an anti-CD20 monoclonal antibody is widely used in PCNSL treatment but its efficacy remains uncertain. Therefore, we conducted a systematic review and meta-analysis to assess the efficacy of rituximab in newly diagnosed adult PCNSL patients.</p> Methods <p>Medline/PubMed and Scopus were searched for studies comparing rituximab/rituximab-containing regimens with therapies not including rituximab in adult PCNSL patients. A random-effects meta-analysis was conducted, and risk ratios (RR) and hazard ratios (HR) were reported with 95% confidence interval (CI). Outcomes included 3- and 5-year overall survival (OS), OS independent of time, 3- and 5-year progression-free survival (PFS), and complete response (CR).</p> Results <p>Sixteen studies (three RCTs, thirteen retrospective) with 2,325 patients (rituximab: 1010; control: 1315) were included. Rituximab-containing therapy was significantly associated with higher 3-year OS (RR: 1.37; 95% CI: 1.07–1.76), higher CR rate (RR: 1.37; 95% CI: 1.05–1.79) and reduced hazard of death (HR: 0.65; 95% CI: 0.43–0.98). 3-year PFS showed a non-significant trend favoring rituximab (RR: 1.29; 95% CI: 0.99–1.68) which reached statistical significance in sensitivity analysis after excluding one study (RR: 1.40; 95% CI: 1.12–1.77). No statistically significant differences were observed for 5-year OS (RR: 1.33; 95% CI: 0.99–1.78) or 5-year PFS (RR: 1.24; 95% CI: 0.79–1.94) between the two groups.</p> Conclusion <p>Our findings indicate that rituximab-containing therapy was associated with improved short-term outcomes in newly diagnosed adult PCNSL. However, long-term advantages remain uncertain. Therefore, there is a need for larger randomized trials with standardized outcome and toxicity reporting and extended follow-up to confirm long-term survival benefit.</p>

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Role of rituximab in treatment of patients with primary central nervous system lymphoma: An updated systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年11月10日

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  • Kumail Mustafa Ali,
  • Muhammad Farhan Ashraf,
  • Zain Ul Abideen,
  • Armish Rehman,
  • Rumman Javed,
  • Ayena Ghulam Mujtaba,
  • Touba Diwan,
  • Ukasha Khalid,
  • Laiba Ikram

摘要

Background

Primary central nervous system lymphoma (PCNSL) is a rare and aggressive form of extranodal non-Hodgkin lymphoma, most often a diffuse large B-cell lymphoma. Rituximab, an anti-CD20 monoclonal antibody is widely used in PCNSL treatment but its efficacy remains uncertain. Therefore, we conducted a systematic review and meta-analysis to assess the efficacy of rituximab in newly diagnosed adult PCNSL patients.

Methods

Medline/PubMed and Scopus were searched for studies comparing rituximab/rituximab-containing regimens with therapies not including rituximab in adult PCNSL patients. A random-effects meta-analysis was conducted, and risk ratios (RR) and hazard ratios (HR) were reported with 95% confidence interval (CI). Outcomes included 3- and 5-year overall survival (OS), OS independent of time, 3- and 5-year progression-free survival (PFS), and complete response (CR).

Results

Sixteen studies (three RCTs, thirteen retrospective) with 2,325 patients (rituximab: 1010; control: 1315) were included. Rituximab-containing therapy was significantly associated with higher 3-year OS (RR: 1.37; 95% CI: 1.07–1.76), higher CR rate (RR: 1.37; 95% CI: 1.05–1.79) and reduced hazard of death (HR: 0.65; 95% CI: 0.43–0.98). 3-year PFS showed a non-significant trend favoring rituximab (RR: 1.29; 95% CI: 0.99–1.68) which reached statistical significance in sensitivity analysis after excluding one study (RR: 1.40; 95% CI: 1.12–1.77). No statistically significant differences were observed for 5-year OS (RR: 1.33; 95% CI: 0.99–1.78) or 5-year PFS (RR: 1.24; 95% CI: 0.79–1.94) between the two groups.

Conclusion

Our findings indicate that rituximab-containing therapy was associated with improved short-term outcomes in newly diagnosed adult PCNSL. However, long-term advantages remain uncertain. Therefore, there is a need for larger randomized trials with standardized outcome and toxicity reporting and extended follow-up to confirm long-term survival benefit.