Ying Yu, Wenjie Xiong, Tingyu Wang, Yuting Yan, Rui Lyu, Qi Wang, Wei Liu, Gang An, Weiwei Sui, Yan Xu, Wenyang Huang, Dehui Zou, Jianxiang Wang, Lugui Qiu, Shuhua Yi
{"title":"循序渐进的治疗可提高瓦尔登斯特罗姆巨球蛋白血症患者的生存率。","authors":"Ying Yu, Wenjie Xiong, Tingyu Wang, Yuting Yan, Rui Lyu, Qi Wang, Wei Liu, Gang An, Weiwei Sui, Yan Xu, Wenyang Huang, Dehui Zou, Jianxiang Wang, Lugui Qiu, Shuhua Yi","doi":"10.1097/BS9.0000000000000179","DOIUrl":null,"url":null,"abstract":"<p><p>Waldenstrom macroglobulinemia (WM) is a type of incurable, indolent B-cell lymphoma that is prone to relapse. Over time, treatment strategies have progressed from cytotoxic drugs to rituximab (R)- or bortezomib (V)-based regimens, and have now entered into an era of Bruton tyrosine kinase inhibitor (BTKi)-based regimens. However, the optimal treatment for the relapsed patients is still unclear. Herein, we analyzed the outcomes of the first- and second-line therapies in 377 patients with WM to illustrate the optimal choices for second-line therapy. After a median follow-up of 45.4 months, 89 patients received second-line therapy, and 53 patients were evaluated for response. The major response rates (MRR) of first- and second-line treatment were 65.1% and 67.9% (<i>P</i> = 0.678). The median progression-free survival (PFS) for the second-line therapy (PFS2) was shorter than that for the first-line therapy (PFS1) (56.3 vs 40.7 months, <i>P</i> = 0.03). However, PFS2 in targeted drugs group (R-/V-/BTKi-based regimens) was comparable to PFS1 (60.7 months vs 44.7 months, respectively, <i>P</i> = 0.21). Regarding second-line therapy, patients who underwent sequential treatment escalation-such as transitioning from cytotoxic drugs to R-/V-/BTKi-based regimens or from R-/V-based to BTKi-based regimens (escalation group) -had higher MRR (80.6% vs 47.1%, respectively, <i>P</i> = 0.023) and longer PFS2 (50.4 vs 23.5 months, respectively, <i>P <</i> 0.001) compared to the non-escalation group. Patients in the escalation group also had longer post-relapse overall survival compared with the non-escalation group (median, 50.4 vs 23.5 months, respectively, <i>P</i> = 0.039). Our findings indicate that sequential treatment escalation may improve the survival of patients with WM.</p>","PeriodicalId":67343,"journal":{"name":"血液科学(英文)","volume":"6 1","pages":"e00179"},"PeriodicalIF":1.5000,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10796142/pdf/","citationCount":"0","resultStr":"{\"title\":\"Sequential treatment escalation improves survival in patients with Waldenstrom macroglobulinemia.\",\"authors\":\"Ying Yu, Wenjie Xiong, Tingyu Wang, Yuting Yan, Rui Lyu, Qi Wang, Wei Liu, Gang An, Weiwei Sui, Yan Xu, Wenyang Huang, Dehui Zou, Jianxiang Wang, Lugui Qiu, Shuhua Yi\",\"doi\":\"10.1097/BS9.0000000000000179\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Waldenstrom macroglobulinemia (WM) is a type of incurable, indolent B-cell lymphoma that is prone to relapse. Over time, treatment strategies have progressed from cytotoxic drugs to rituximab (R)- or bortezomib (V)-based regimens, and have now entered into an era of Bruton tyrosine kinase inhibitor (BTKi)-based regimens. However, the optimal treatment for the relapsed patients is still unclear. Herein, we analyzed the outcomes of the first- and second-line therapies in 377 patients with WM to illustrate the optimal choices for second-line therapy. After a median follow-up of 45.4 months, 89 patients received second-line therapy, and 53 patients were evaluated for response. The major response rates (MRR) of first- and second-line treatment were 65.1% and 67.9% (<i>P</i> = 0.678). The median progression-free survival (PFS) for the second-line therapy (PFS2) was shorter than that for the first-line therapy (PFS1) (56.3 vs 40.7 months, <i>P</i> = 0.03). However, PFS2 in targeted drugs group (R-/V-/BTKi-based regimens) was comparable to PFS1 (60.7 months vs 44.7 months, respectively, <i>P</i> = 0.21). Regarding second-line therapy, patients who underwent sequential treatment escalation-such as transitioning from cytotoxic drugs to R-/V-/BTKi-based regimens or from R-/V-based to BTKi-based regimens (escalation group) -had higher MRR (80.6% vs 47.1%, respectively, <i>P</i> = 0.023) and longer PFS2 (50.4 vs 23.5 months, respectively, <i>P <</i> 0.001) compared to the non-escalation group. Patients in the escalation group also had longer post-relapse overall survival compared with the non-escalation group (median, 50.4 vs 23.5 months, respectively, <i>P</i> = 0.039). 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引用次数: 0
摘要
Waldenstrom巨球蛋白血症(WM)是一种难以治愈、易复发的不显性B细胞淋巴瘤。随着时间的推移,治疗策略已从细胞毒药物发展到以利妥昔单抗(R)或硼替佐米(V)为基础的方案,目前已进入以布鲁顿酪氨酸激酶抑制剂(BTKi)为基础的方案时代。然而,复发患者的最佳治疗方案仍不明确。在此,我们分析了377例WM患者的一线和二线治疗结果,以说明二线治疗的最佳选择。中位随访45.4个月后,89名患者接受了二线治疗,53名患者接受了反应评估。一线和二线治疗的主要反应率(MRR)分别为65.1%和67.9%(P = 0.678)。二线治疗的中位无进展生存期(PFS2)比一线治疗的中位无进展生存期(PFS1)短(56.3 个月对 40.7 个月,P = 0.03)。然而,靶向药物组(基于R-/V-/BTKi的方案)的PFS2与PFS1相当(分别为60.7个月 vs 44.7个月,P = 0.21)。在二线治疗方面,与未升级治疗组相比,进行了序贯治疗升级(如从细胞毒性药物过渡到基于R-/V-/BTKi的方案或从基于R-/V-方案过渡到基于BTKi的方案(升级组))的患者具有更高的MRR(分别为80.6% vs 47.1%,P = 0.023)和更长的PFS2(分别为50.4个月 vs 23.5个月,P 0.001)。与非升级治疗组相比,升级治疗组患者的复发后总生存期也更长(中位数分别为50.4个月和23.5个月,P = 0.039)。我们的研究结果表明,循序渐进的治疗可提高WM患者的生存率。
Sequential treatment escalation improves survival in patients with Waldenstrom macroglobulinemia.
Waldenstrom macroglobulinemia (WM) is a type of incurable, indolent B-cell lymphoma that is prone to relapse. Over time, treatment strategies have progressed from cytotoxic drugs to rituximab (R)- or bortezomib (V)-based regimens, and have now entered into an era of Bruton tyrosine kinase inhibitor (BTKi)-based regimens. However, the optimal treatment for the relapsed patients is still unclear. Herein, we analyzed the outcomes of the first- and second-line therapies in 377 patients with WM to illustrate the optimal choices for second-line therapy. After a median follow-up of 45.4 months, 89 patients received second-line therapy, and 53 patients were evaluated for response. The major response rates (MRR) of first- and second-line treatment were 65.1% and 67.9% (P = 0.678). The median progression-free survival (PFS) for the second-line therapy (PFS2) was shorter than that for the first-line therapy (PFS1) (56.3 vs 40.7 months, P = 0.03). However, PFS2 in targeted drugs group (R-/V-/BTKi-based regimens) was comparable to PFS1 (60.7 months vs 44.7 months, respectively, P = 0.21). Regarding second-line therapy, patients who underwent sequential treatment escalation-such as transitioning from cytotoxic drugs to R-/V-/BTKi-based regimens or from R-/V-based to BTKi-based regimens (escalation group) -had higher MRR (80.6% vs 47.1%, respectively, P = 0.023) and longer PFS2 (50.4 vs 23.5 months, respectively, P < 0.001) compared to the non-escalation group. Patients in the escalation group also had longer post-relapse overall survival compared with the non-escalation group (median, 50.4 vs 23.5 months, respectively, P = 0.039). Our findings indicate that sequential treatment escalation may improve the survival of patients with WM.