Front-line treatment for follicular lymphoma has evolved with the introduction of maintenance therapy, bendamustine (Benda), obinutuzumab (G), and lenalidomide (Len). We conducted a random-effects Bayesian network meta-analysis (NMA) of phase 3 randomized controlled trials (RCTs) to identify the regimens with superior efficacy. Progression-free survival (PFS) was compared between 11 modern regimens with different immunochemotherapy and maintenance strategies. G-Benda-G resulted in with the best PFS, with an HR of 0.41 compared to R-Benda, a surface under the cumulative ranking curve (SUCRA) of 0.97, a probability of being the best treatment (PbBT) of 72%, and a posterior ranking distribution (PoRa) of 1 (95% BCI 1–3). This was followed by R-Benda-R4 (HR = 0.49, PbBT = 25%, PoRa = 2) and R-Benda-R (HR = 0.60, PbBT = 3%, PoRa = 3). R-CHOP-R (HR = 0.96) and R-Len-R (HR = 0.97) had similar efficacy to R-Benda. Bendamustine was a better chemotherapy backbone than CHOP either with maintenance (R-Benda-R vs R-CHOP-R, HR = 0.62; G-Benda-G vs G-CHOP-G, HR = 0.55) or without maintenance therapy (R-Benda vs R-CHOP, HR = 0.68). Rituximab maintenance improved PFS following R-CHOP (R-CHOP-R vs R-CHOP, HR = 0.65) or R-Benda (R-Benda-R vs R-Benda, HR = 0.60; R-Benda-R4 vs R-Benda, HR = 0.49). In the absence of multi-arm RCTs that include all common regimens, this NMA provides an important and useful guide to inform treatment decisions.

随着维持治疗、苯达莫司汀 (Benda)、奥比妥珠单抗 (G) 和来那度胺 (Len) 的引入，滤泡性淋巴瘤的一线治疗不断发展。我们对 3 期随机对照试验 (RCT) 进行了随机效应贝叶斯网络荟萃分析 (NMA)，以确定具有优异疗效的治疗方案。比较了采用不同免疫化疗和维持策略的 11 种现代治疗方案的无进展生存期 (PFS)。 G-Benda-G 具有最佳 PFS，与 R-Benda 相比，HR 为 0.41，累积排序曲线下表面 (SUCRA) 为 0.97，成为最佳治疗的概率 (PbBT) 为 72%，后验排序分布 (PoRa) 为 1 (95% BCI 1–3)。其次是 R-Benda-R4（HR = 0.49，PbBT = 25%，PoRa = 2）和 R-Benda-R（HR = 0.60，PbBT = 3%，PoRa = 3）。 R-CHOP-R (HR = 0.96) 和 R-Len-R (HR = 0.97) 与 R-Benda 具有相似的功效。苯达莫司汀是比 CHOP 更好的化疗骨干，无论是维持治疗（R-Benda-R 对比 R-CHOP-R，HR = 0.62；G-Benda-G 对比 G-CHOP-G，HR = 0.55）或不进行维持治疗（R -Benda 与 R-CHOP，HR = 0.68）。 R-CHOP（R-CHOP-R 与 R-CHOP，HR = 0.65）或 R-Benda（R-Benda-R 与 R-Benda，HR = 0.60；R-Benda-R4 与 R-本达，HR = 0.49）。在缺乏涵盖所有常见治疗方案的多臂随机对照试验的情况下，本 NMA 为治疗决策提供了重要且有用的指导。