BTK抑制剂治疗复发或难治慢性淋巴细胞白血病有效性和安全性的Meta分析OA

Objective To systematically evaluate the efficacy and safety of different Bruton's tyrosine kinase(BTK)inhibitors as monotherapy for patients with relapsed or refractory chronic lymphocytic leukemia(R/R CLL).Methods All relevant literature was retrieved from the PubMed,Embase,Cochrane Library,China National Knowledge Infrastructure,Wanfang Data Knowledge Service Platform and VIP,from their inception to October 15,2024.Studies that met the inclusion criteria were quality assessed,and data on efficacy and safety were extracted.A single-arm Meta-analysis was performed using R 4.2.2,and publication bias was examined with funnel plots and Egger's test.Results Results A total of 31 studies were included,providing 33 BTK inhibitor monotherapy arms.Including monotherapy data of ibrutinib(n=21),acalabrutinib(n=5),zanubrutinib(n=3),tirabrutinib(n=2),orelabrutinib(n=1),and nemtabrutinib(n=1).The overall response rate(ORR)and complete response rate(CRR)were 80.4%(95%CI:0.758-0.846)and 6.9%(95%CI:0.040-0.103),respectively.Subgroup analysis showed that orelabrutinib achieved the highest ORR(92.5%,)and CRR(21.2%)among all BTK inhibitors(P<0.01).The overall incidence of grade≥3 adverse events was 61.1%(95%CI:0.500-0.717),with the most common events being bleeding(26.2%),diarrhea(24.3%),and neutropenia(22.7%).Conclusion BTK inhibitor monotherapy exhibits favorable efficacy in R/R CLL.Some next-generation BTK inhibitors showed relatively higher response rates;However,these findings should be interpreted cautiously due to the limited number of studies.