Use of rituximab in mature, high-grade and advanced-stage pediatric B-lineage non-Hodgkin lymphomas: a systematic review, meta-analysis and the Brazilian reality
ObjectivesRituximab is a valuable agent for treating adult B-cell non-Hodgkin lymphoma (B-NHL), and several studies have tested its efficacy in children with mature, high-grade B-NHL. The aim of the present study was to systematically review the use of rituximab in children and adolescents with high...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2025.1532274/full |
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| author | Alejandra Adriana Cardoso de Castro Alejandra Adriana Cardoso de Castro Alejandra Adriana Cardoso de Castro Liana Alves de Oliveira Liana Alves de Oliveira Diancarlos Pereira de Andrade Edna Kakitani Carbone Edna Kakitani Carbone Roberto Rosati Roberto Rosati Roberto Rosati |
| author_facet | Alejandra Adriana Cardoso de Castro Alejandra Adriana Cardoso de Castro Alejandra Adriana Cardoso de Castro Liana Alves de Oliveira Liana Alves de Oliveira Diancarlos Pereira de Andrade Edna Kakitani Carbone Edna Kakitani Carbone Roberto Rosati Roberto Rosati Roberto Rosati |
| author_sort | Alejandra Adriana Cardoso de Castro |
| collection | DOAJ |
| description | ObjectivesRituximab is a valuable agent for treating adult B-cell non-Hodgkin lymphoma (B-NHL), and several studies have tested its efficacy in children with mature, high-grade B-NHL. The aim of the present study was to systematically review the use of rituximab in children and adolescents with high-grade mature B-NHL and to conduct a meta-analysis of the evidence. Since access to this medication in public health systems in low- and middle-income countries is complex, we were also interested in mapping access to it in Brazil.MethodsWe conducted a systematic review and meta-analysis on the survival of pediatric patients with mature, high-grade and advanced-stage B-NHL treated with rituximab in combination with chemotherapy in first-line treatment or later. Patients' access to the medication was evaluated through a questionnaire sent to oncologists in Brazilian pediatric oncology centers.ResultsWe selected 17 trials, which were subsequently grouped by disease type and line of therapy. In patients receiving first-line treatment, excluding those with primary mediastinal B-cell lymphoma (PMBL), the use of rituximab resulted in (1) better event-free survival [Hazard Ratio of 0.37 (0.22, 0.61); p < 0.01]; (2) a reduced risk of events [odds ratio of 0.44 (0.26–0.76); p = 0.003]; and (3) a reduced risk of death [odds ratio of 0.44 (0.21–0.89); p = 0.02]. In refractory or relapsed (R/R) patients, rituximab use was associated with a decreased chance of death [odds ratio of 0.25 (0.09–0.75); p = 0.01]. Additionally, our survey included 31 Brazilian centers, 63% of which reported bearing the cost of rituximab.ConclusionRituximab improves outcomes in pediatric patients receiving first-line treatment for high-grade B-NHL (except PBML) and overall survival in R/R patients. However, access to rituximab in Brazilian hospitals is currently dependent on centers supporting its economic burden.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, PROSPERO (CRD42021292912). |
| format | Article |
| id | doaj-art-8cfd029f3e80406c83ba49ccf305ad4a |
| institution | Kabale University |
| issn | 2296-2360 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pediatrics |
| spelling | doaj-art-8cfd029f3e80406c83ba49ccf305ad4a2025-01-20T17:00:59ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602025-01-011310.3389/fped.2025.15322741532274Use of rituximab in mature, high-grade and advanced-stage pediatric B-lineage non-Hodgkin lymphomas: a systematic review, meta-analysis and the Brazilian realityAlejandra Adriana Cardoso de Castro0Alejandra Adriana Cardoso de Castro1Alejandra Adriana Cardoso de Castro2Liana Alves de Oliveira3Liana Alves de Oliveira4Diancarlos Pereira de Andrade5Edna Kakitani Carbone6Edna Kakitani Carbone7Roberto Rosati8Roberto Rosati9Roberto Rosati10Department of Pediatric Oncology and Hematology, Pequeno Principe Hospital, Curitiba, BrazilFaculdades Pequeno Príncipe, Curitiba, BrazilNationalScience and Technology Institute for Children’s Cancer Biology and Pediatric Oncology, INCT BioOncoPed, Porto Alegre, BrazilNationalScience and Technology Institute for Children’s Cancer Biology and Pediatric Oncology, INCT BioOncoPed, Porto Alegre, BrazilPelé Pequeno Príncipe Research Institute, Curitiba, BrazilFaculdades Pequeno Príncipe, Curitiba, BrazilDepartment of Pediatric Oncology and Hematology, Pequeno Principe Hospital, Curitiba, BrazilNationalScience and Technology Institute for Children’s Cancer Biology and Pediatric Oncology, INCT BioOncoPed, Porto Alegre, BrazilFaculdades Pequeno Príncipe, Curitiba, BrazilNationalScience and Technology Institute for Children’s Cancer Biology and Pediatric Oncology, INCT BioOncoPed, Porto Alegre, BrazilPelé Pequeno Príncipe Research Institute, Curitiba, BrazilObjectivesRituximab is a valuable agent for treating adult B-cell non-Hodgkin lymphoma (B-NHL), and several studies have tested its efficacy in children with mature, high-grade B-NHL. The aim of the present study was to systematically review the use of rituximab in children and adolescents with high-grade mature B-NHL and to conduct a meta-analysis of the evidence. Since access to this medication in public health systems in low- and middle-income countries is complex, we were also interested in mapping access to it in Brazil.MethodsWe conducted a systematic review and meta-analysis on the survival of pediatric patients with mature, high-grade and advanced-stage B-NHL treated with rituximab in combination with chemotherapy in first-line treatment or later. Patients' access to the medication was evaluated through a questionnaire sent to oncologists in Brazilian pediatric oncology centers.ResultsWe selected 17 trials, which were subsequently grouped by disease type and line of therapy. In patients receiving first-line treatment, excluding those with primary mediastinal B-cell lymphoma (PMBL), the use of rituximab resulted in (1) better event-free survival [Hazard Ratio of 0.37 (0.22, 0.61); p < 0.01]; (2) a reduced risk of events [odds ratio of 0.44 (0.26–0.76); p = 0.003]; and (3) a reduced risk of death [odds ratio of 0.44 (0.21–0.89); p = 0.02]. In refractory or relapsed (R/R) patients, rituximab use was associated with a decreased chance of death [odds ratio of 0.25 (0.09–0.75); p = 0.01]. Additionally, our survey included 31 Brazilian centers, 63% of which reported bearing the cost of rituximab.ConclusionRituximab improves outcomes in pediatric patients receiving first-line treatment for high-grade B-NHL (except PBML) and overall survival in R/R patients. However, access to rituximab in Brazilian hospitals is currently dependent on centers supporting its economic burden.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, PROSPERO (CRD42021292912).https://www.frontiersin.org/articles/10.3389/fped.2025.1532274/fullrituximablymphomanon-Hodgkin lymphomaB cell lymphomapediatrics |
| spellingShingle | Alejandra Adriana Cardoso de Castro Alejandra Adriana Cardoso de Castro Alejandra Adriana Cardoso de Castro Liana Alves de Oliveira Liana Alves de Oliveira Diancarlos Pereira de Andrade Edna Kakitani Carbone Edna Kakitani Carbone Roberto Rosati Roberto Rosati Roberto Rosati Use of rituximab in mature, high-grade and advanced-stage pediatric B-lineage non-Hodgkin lymphomas: a systematic review, meta-analysis and the Brazilian reality Frontiers in Pediatrics rituximab lymphoma non-Hodgkin lymphoma B cell lymphoma pediatrics |
| title | Use of rituximab in mature, high-grade and advanced-stage pediatric B-lineage non-Hodgkin lymphomas: a systematic review, meta-analysis and the Brazilian reality |
| title_full | Use of rituximab in mature, high-grade and advanced-stage pediatric B-lineage non-Hodgkin lymphomas: a systematic review, meta-analysis and the Brazilian reality |
| title_fullStr | Use of rituximab in mature, high-grade and advanced-stage pediatric B-lineage non-Hodgkin lymphomas: a systematic review, meta-analysis and the Brazilian reality |
| title_full_unstemmed | Use of rituximab in mature, high-grade and advanced-stage pediatric B-lineage non-Hodgkin lymphomas: a systematic review, meta-analysis and the Brazilian reality |
| title_short | Use of rituximab in mature, high-grade and advanced-stage pediatric B-lineage non-Hodgkin lymphomas: a systematic review, meta-analysis and the Brazilian reality |
| title_sort | use of rituximab in mature high grade and advanced stage pediatric b lineage non hodgkin lymphomas a systematic review meta analysis and the brazilian reality |
| topic | rituximab lymphoma non-Hodgkin lymphoma B cell lymphoma pediatrics |
| url | https://www.frontiersin.org/articles/10.3389/fped.2025.1532274/full |
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