来那度胺维持治疗复发或难治性经典霍奇金淋巴瘤自体移植后的初步研究

IF 4.3 Q1 Medicine
Lauren Shea , Marcus P. Watkins , Fei Wan , Amanda F. Cashen , Nina D. Wagner-Johnston , Meagan A. Jacoby , Camille N. Abboud , John F. Dipersio , David D. Hurd , Samantha M. Jaglowski , Nancy L. Bartlett , Todd A. Fehniger
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引用次数: 3

摘要

对于复发或难治性经典霍奇金淋巴瘤(cHL)患者,补救性化疗后自体干细胞移植(ASCT)巩固仍然是标准的治疗方法。即使采用这种积极的治疗策略,5年无进展生存率仍≤50%,并且仍有兴趣采用维持策略来提高长期无病生存率。来那度胺是一种免疫调节剂,在包括cHL在内的多种淋巴瘤亚型中具有活性,并且也被证明可以改善多发性骨髓瘤ASCT后的无进展和总生存期。这项多中心研究评估了来那度胺对cHL患者ASCT后的维持作用。患者在移植后60至90天入组,在28天周期的第1至28天口服来那度胺,最多18个周期。来那度胺起始剂量为每日15毫克,如果耐受,则增加至每日最大剂量25毫克。本研究的主要目的是评估该方案的可行性,目标是在第12周期或之前因药物相关原因停药的比率为30%。27例患者入组,其中26例接受了至少1剂来那度胺治疗。中位随访51.3个月(范围12.2 - 76.2个月),26例患者中有23例存活。中位无事件生存期为9.4个月,中位无进展生存期未达到,26例患者中有17例(65.4%)在最后随访时仍处于缓解期。排除4名因进展而停药的患者和2名因不依从性而停药的患者,在第12周期或之前的停药率为52%。治疗伴有高频率的血液学不良事件,15名患者(58%)出现3至4级血液学毒性,5名患者(19%)出现4级血液学毒性。我们的结论是,本研究中探索的来那度胺维持方案对于ASCT后立即发生cHL的患者是不可行的。对于复发或难治性cHL患者,ASCT后替代来那度胺剂量或方案可能耐受性更好。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A Pilot Study of Lenalidomide Maintenance Therapy after Autologous Transplantation in Relapsed or Refractory Classical Hodgkin Lymphoma

For patients with relapsed or refractory classical Hodgkin lymphoma (cHL), salvage chemotherapy followed by consolidation with autologous stem cell transplant (ASCT) remains the standard of care. Even with this aggressive treatment strategy, 5-year progression-free survival is ≤50%, and there remains interest in maintenance strategies to improve long-term disease-free survival. Lenalidomide is an immunomodulatory agent with demonstrated activity in multiple subtypes of lymphoma including cHL, and has also been shown to improve both progression-free and overall survival as maintenance therapy after ASCT in multiple myeloma. This multicenter study evaluated maintenance lenalidomide after ASCT for patients with cHL. Patients were enrolled 60 to 90 days post-transplant and received oral lenalidomide on days 1 to 28 of 28-day cycles for a maximum of 18 cycles. Lenalidomide was started at 15 mg daily and increased to maximum of 25 mg daily if tolerated. The primary objective of this study was to assess the feasibility of this regimen, with a goal <30% rate of discontinuation at or before cycle 12 for drug-related reasons. Twenty-seven patients were enrolled and 26 received at least 1 dose of lenalidomide. With a median follow-up of 51.3 months (range, 12.2 to 76.2 months), 23 of 26 patients were alive. Median event-free survival was 9.4 months and median progression-free survival had not been reached, with 17 of 26 patients (65.4%) remaining in remission at last follow-up. Excluding 4 patients who discontinued therapy for progression and 2 who discontinued due to noncompliance, the discontinuation rate at or before cycle 12 was 52%. Treatment was complicated by a high frequency of hematologic adverse events, with 15 patients (58%) experiencing grade 3 to 4 hematologic toxicity and 5 (19%) experiencing grade 4 hematologic toxicity. We conclude that the regimen of maintenance lenalidomide explored in this study is not feasible for patients with cHL immediately following ASCT. An alternative lenalidomide dose or schedule may be better tolerated following ASCT for patients with relapsed or refractory cHL.

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来源期刊
CiteScore
6.60
自引率
0.00%
发文量
1061
审稿时长
3-6 weeks
期刊介绍: Biology of Blood and Marrow Transplantation publishes original research reports, reviews, editorials, commentaries, letters to the editor, and hypotheses and is the official publication of the American Society for Transplantation and Cellular Therapy. The journal focuses on current technology and knowledge in the interdisciplinary field of hematopoetic stem cell transplantation.
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