Outcomes in first relapsed-refractory younger patients with mantle cell lymphoma: results from the MANTLE-FIRST study
Outcomes in first relapsed-refractory younger patients with mantle cell lymphoma: results from the MANTLE-FIRST study
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DOI：
10.1038/s41375-020-01013-3
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发表时间：
2020-08-11
期刊：
影响因子：
11.4
通讯作者：
Balzarotti, Monica
中科院分区：
文献类型：
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作者：
Visco, Carlo;Di Rocco, Alice;Balzarotti, Monica
诱导治疗失败的套细胞淋巴瘤（MCL）患者是一个难以治疗的群体，没有标准的治疗方法。我们评估了首次复发难治性（r/r） MCL患者在前期高剂量阿糖胞苷包括标准方案后的结果。总生存期（OS-2）和无进展生存期（PFS-2）从补救性治疗开始估计。先前描述的24个月阈值用于定义早期或晚期进展（POD）患者。总的来说，261名复发/复发的MCL患者被纳入研究。二线方案包括利妥昔单抗-苯达莫司汀（R-B, 21%）， R-B和阿糖胞苷（R-BAC, 29%），依鲁替尼（19%）和其他（31%）。四组在临床病理特征方面是平衡的。调整年龄和早期/晚期pod后，接受R-BAC治疗的患者完全缓解率（63%）明显高于对照组。总体而言，与R-B（13）或其他(7)相比，Ibrutinib和R-BAC与改善中位PFS-2相关[分别为24和25个月]。在早期pod患者中（n = 127）， ibrutinib与比较组的死亡风险较低（R-B组的HR为2.41，其他组为2.17，R-BAC组为2.78）。在晚期pod患者（n = 134）中，依鲁替尼和苯达莫司汀为基础的治疗没有显著差异。伊鲁替尼与早期pod患者预后改善相关。
Patients with mantle cell lymphoma (MCL) that fail induction treatment represent a difficult-to-treat population, where no standard therapy exists. We evaluated outcomes in patients with first relapsed-refractory (r/r) MCL after upfront high dose cytarabine including standard regimens. Overall survival (OS-2) and progression-free survival (PFS-2) were estimated from the time of salvage therapy. The previously described threshold of 24 months was used to define patients as early- or late-progressors (POD). Overall, 261 r/r MCL patients were included. Second-line regimens consisted of rituximab-bendamustine (R-B, 21%), R-B and cytarabine (R-BAC, 29%), ibrutinib (19%), and others (31%). The four groups were balanced in terms of clinicopathological features. Adjusting for age and early/late-POD, patients treated with R-BAC had significantly higher complete remission (63%) than comparators. Overall, Ibrutinib and R-BAC were associated with improved median PFS-2 [24 and 25 months, respectively], compared to R-B (13) or others (7). In patients with early-POD (n = 127), ibrutinib was associated with inferior risk of death than comparators (HR 2.41 for R-B, 2.17 for others, 2.78 for R-BAC). In patients with late-POD (n = 134), no significant differences were observed between ibrutinib and bendamustine-based treatments. Ibrutinib was associated with improved outcome in early-POD patients.