Rituximab and Bendamustine (BR) Compared with Rituximab, Bendamustine, and Cytarabine (R-BAC) in Previously Untreated Elderly Patients with Mantle Cell Lymphoma.
Rituximab and Bendamustine (BR) Compared with Rituximab, Bendamustine, and Cytarabine (R-BAC) in Previously Untreated Elderly Patients with Mantle Cell Lymphoma.
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DOI：
10.3390/cancers13236089
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发表时间：
2021-12-03
期刊：
影响因子：
5.2
通讯作者：
Visco C
中科院分区：
文献类型：
--
作者：
Bega G;Olivieri J;Riva M;Scapinello G;Paolini R;Finotto S;Sartori R;Lucchini E;Guandalini G;Facchinelli D;Tisi MC;Basso M;Ballotta L;Piazza F;Ferrarini I;Visco C
BR和R-BAC都是老年套细胞淋巴瘤（MCL）患者的合适诱导疗法。然而，这两种方案之前没有比较过。我们回顾性分析了2008年至2019年间8家机构接受BR或R-BAC治疗的新诊断MCL老年患者的结局和安全性特征。我们使用倾向评分来减少选择偏差，因此分析了156例患者（53例BR， 103例R-BAC）。接受R-BAC治疗的患者的CR率高于BR（91%对60%，p < 0.0001）。R-BAC和BR的2年PFS分别为87±3%和64±7% （p = 0.001）。R-BAC的中位总生存期（OS）为121个月，BR为78个月（p = 0.08）。R-BAC与3-4级血小板减少症的相关性明显高于BR（50%对17%）。该研究表明，与BR相比，R-BAC与老年MCL患者2年PFS显著延长相关。背景：根据临床指南，利妥昔单抗+苯达莫司汀（BR）和利妥昔单抗+苯达莫司汀+阿糖胞苷（R-BAC）是老年套细胞淋巴瘤（MCL）患者中众所周知的诱导疗法。然而，两种方案之间的直接比较从未进行过。方法：在这项多中心回顾性研究中，我们比较了新诊断的MCL患者接受BR或R-BAC治疗的结果。主要终点为2年无进展生存期（PFS）。采用按性别、年龄、MCL形态和MIPI评分分层的倾向评分来评估纳入偏倚。结果：经倾向评分调整后，我们确定了156例患者（53例BR， 103例R-BAC），中位年龄为72岁（53 - 90岁）。中位随访时间为46个月（范围12-133）。51%的患者以2天疗程或减剂量给予R-BAC。接受R-BAC治疗的患者达到CR的比例为91%，而接受BR治疗的患者为60% （p < 0.0001）。R-BAC和BR的2年PFS分别为87±3%和64±7% （p = 0.001）。在毒性方面，R-BAC与3-4级血小板减少症的相关性明显高于BR（50%对17%）。结论：该研究表明，对于先前未治疗的MCL老年患者，R-BAC，即使在适当减剂量的情况下，与BR相比，与显著延长2年PFS相关。
Both BR, and R-BAC are suitable induction therapies in elderly patients with mantle cell lymphoma (MCL). However, the two regimens have not been compared before. We retrospectively analysed the outcome and the safety features of elderly patients with newly diagnosed MCL, treated with BR or R-BAC between 2008 and 2019 at eight institutions. We used propensity scores to reduce selection bias, thus analysing 156 patients (53 BR, 103 R-BAC). Patients treated with R-BAC achieved higher CR rate than BR (91% vs. 60%, p < 0.0001). The 2-year PFS was 87 ± 3% and 64 ± 7% for R-BAC and BR, respectively (p = 0.001). Median overall survival (OS) was 121 months for R-BAC and 78 months for BR (p = 0.08). R-BAC was associated with significantly more pronounced grade 3–4 thrombocytopenia than BR (50% vs. 17%). This study indicates that R-BAC is associated with significantly prolonged 2-year PFS than BR in elderly patients with MCL. Background: Rituximab plus bendamustine (BR), and rituximab, bendamustine, and cytarabine (R-BAC) are well-known induction therapies in elderly patients with mantle cell lymphoma (MCL), according to clinical guidelines. However, a direct comparison between the two regimens has never been performed. Methods: In this multicentre retrospective study, we compared the outcome of patients with newly diagnosed MCL, treated with BR or R-BAC. Primary endpoint was 2-year progression-free survival (PFS). Inclusion bias was assessed using a propensity score stratified by gender, age, MCL morphology, and MIPI score. Results: After adjusting by propensity score, we identified 156 patients (53 BR, 103 R-BAC) with median age of 72 (53–90). Median follow-up was 46 months (range 12–133). R-BAC was administered in a 2-day schedule or with attenuated dose in 51% of patients. Patients treated with R-BAC achieved CR in 91% of cases, as compared with 60% for BR (p < 0.0001). The 2-year PFS was 87 ± 3% and 64 ± 7% for R-BAC and BR, respectively (p = 0.001). In terms of toxicity, R-BAC was associated with significantly more pronounced grade 3–4 thrombocytopenia than BR (50% vs. 17%). Conclusions: This study indicates that R-BAC, even when administered with judiciously attenuated doses, is associated with significantly prolonged 2-year PFS than BR in elderly patients with previously untreated MCL.
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