The Role of Radiotherapy in Relapse/Refractory Diffuse Large B-Cell Lymphoma in the Rituximab Era: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Purpose: The role of radiotherapy (RT) in the salvage setting for patients with relapsed/refractory (r/r) diffuse large B-cell lymphoma (DLBCL) is unclear in the rituximab era. We sought to determine the efficacy and toxicity of RT for this group of patients. Methods: We searched various biomedical databases, including conference proceedings, for eligible studies where patients were treated with salvage radiotherapy for r/r DLBCL after receiving rituximab based chemotherapy regime. Random-effects meta-analysis with inverse variance weighting to pool prevalence data was performed. Outcomes of interest were 2 and 5-year overall survival (OS-2, OS-5), 2 and 5-year progression free survival (PFS-2, PFS-5) and Grade 3 or 4 adverse events (AE). Study quality was assessed using the Newcastle-Ottawa scoring system. Results: We found 12 eligible non-comparative studies including 387 patients who received rituximab based chemotherapy as first line treatment and subsequently relapsed or had residual disease on post treatment restaging imaging. The OS-2 and OS-5 was 90% (95% CI, 84 – 95%) and 83% (95% CI, 76 – 89%) respectively. Similarly, PFS-2 and PFS-5 were 81% (95% CI, 72 – 90%) and 74% (95% CI, 65 – 82%) respectively. Sub-group analysis showed that studies with prospective design had higher rates of OS-2 and OS-5 compared with studies of retrospective design (OS-2: 97% vs 81%, interaction P (IP) = 0.009; OS-5: 95% vs 75%, IP = 0.003). and studies with peri-transplant RT had lower rates of OS-5 compared to studies with salvage RT alone (59% vs 77%, IP = 0.03). Conclusion: The available evidence, albeit low quality, suggests that salvage radiotherapy provides encouraging disease control and survival rates. It also emphasizes the need for high-quality randomized trials to establish how RT can be integrated optimally in this setting. Keywords: Radiotherapy; Relapsed; Refractory; Diffuse large B-cell lymphoma; Salvage
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.027 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.031 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".