Role of Rituximab in Treatment of Patients With Primary Central Nervous System Lymphoma (PCNSL): A Systematic Review and Meta-Analysis

Primary central nervous system lymphoma (PCNSL) is a rare form of non-Hodgkin's lymphoma involving the brain, cerebrospinal fluid, spinal cordand eyes. Rituximab has played a prominent role in the treatment of non-Hodgkin's B-cell lymphomas, including aggressive diffuse large B lymphoma. However, as a macromolecular drug, the role of rituximab in the treatment of PCNSL has been controversial. In this systematic review and meta-analysis, we evaluated the role of rituximab in the treatment of PCNSL. We searched articles in the following electronic databases including PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov until 20 October 2022.We included 11 studies (3 RCTS and 8 retrospective studies) with a total of 1182 patients. We extracted the baseline characteristics and outcomes of the studies and assessed the risk of bias, then used Review Manager5.4 for this meta-analysis. The primary outcomes included complete response rate (CR), overall survival (OS), and progression-free survival (PFS). Odds ratios (ors) and corresponding 95% confidence intervals (cis) for the primary outcome were analyzed and compared. The results of our statistical analysis show that the use of rituximab was closely correlated with a higher CR(OR 1.70,95%CI 1.17-2.46,P=0.005), 3-year OS(OR 2.40,95%CI 1.53-3.77,P=0.0001), 5-year OS(OR 2.75,95%CI 1.68-4.49,P<0.0001), 3-year PFS(OR 4.42,95%CI 1.15-16.97,P<0.0001), 5-year PFS(OR 1.97,95%CI 1.39-2.78,P=0.0001).These results suggest that rituximab may have a positive impact on the prognosis of patients with PCNSL,and may be helpful in the determination of treatment plan for patients with PCNSL.