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。

IF 1.5 Q3 HEMATOLOGY
血液科学(英文) Pub Date : 2024-01-17 eCollection Date: 2024-01-01 DOI:10.1097/BS9.0000000000000179
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
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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。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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.

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