本系统文献综述 (CRD42023393903) 和贝叶斯网络荟萃分析 (NMA) 旨在评估一线靶向治疗（acalabrutinib、ibrutinib、obinutuzumab、ofatumumab、pirtobrutinib、ublituximab、umbralisib、venetoclax、zanubrutinib）在高龄和/或合并症的慢性淋巴细胞白血病（CLL）患者。 NMA 显示，就总体安全性（例如，严重不良事件 [AE] 1-5 级）而言，zanubrutinib 是最安全的治疗选择，其次是 Venetoclax-obinutuzumab，后者在 AE 1-5 级方面显示出优势。就血液学 AE 风险而言，使用布鲁顿酪氨酸激酶抑制剂 (BTKi) 单一疗法更为有利，但化学免疫疗法在心血管、胃肠道和感染性 AE 方面显示出优势。治疗之间继发性癌症的风险相似。总之，靶向治疗与可变且临床相关的 AE 相关。对于高龄和/或合并症的初治 CLL 患者，这些疗法作为单一疗法使用似乎比与免疫药物联合使用更安全。版权所有 © 2024。由 Elsevier B.V. 出版。

This systematic literature review (CRD42023393903) and a Bayesian network meta-analysis (NMA) aimed to assess the relative safety profile of first-line targeted therapies (acalabrutinib, ibrutinib, obinutuzumab, ofatumumab, pirtobrutinib, ublituximab, umbralisib, venetoclax, zanubrutinib) in chronic lymphocytic leukaemia (CLL) patients with advanced age and/or comorbidities. The NMA revealed that zanubrutinib was the safest treatment option in terms of the overall safety profile (e.g., serious adverse events [AEs] grade 1-5), followed by venetoclax-obinutuzumab, which showed an advantage in terms of AEs grade 1-5. The use of Bruton's tyrosine kinase inhibitor (BTKi) monotherapy was more favourable in terms of the risk of haematological AEs, but chemoimmunotherapy showed advantages in terms of cardiovascular, gastrointestinal, and infectious AEs. The risk of secondary cancers was similar between treatments. In conclusion, targeted therapies are associated with variable and clinically relevant AEs. The therapies appear to be safer when used as monotherapy rather than in combination with immunological agents in naïve CLL patients with advanced age and/or comorbidities.Copyright © 2024. Published by Elsevier B.V.