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Lancet Haematol:MATRix–RICE方案联合自体HSCT治疗继发CNS浸润的弥漫大B细胞淋巴瘤的疗效显著

2021-02-07 MedSci原创 MedSci原创

继发性中枢神经系统(CNS)淋巴瘤在弥漫性大B细胞淋巴瘤患者中是一种罕见但具有潜在致命性的事件。

继发性中枢神经系统(CNS)淋巴瘤在弥漫性大B细胞淋巴瘤患者中是一种罕见但具有潜在致命性的事件。本研究旨在评估通过自体造血干细胞移植(HSCT)强化的CNS定向免疫化疗法在继发性CNS淋巴瘤患者中的活性和安全性。

这项国际性的单臂2期试验在意大利、英国、荷兰和瑞士的24家医院进行。招募组织学诊断为弥漫性大B细胞淋巴瘤和CNS受累的初诊或复发性、ECOG表现状态≤3分的成年患者(18-70岁),予以三个疗程的MATRix治疗(利妥昔单抗+甲氨蝶呤+阿糖胞苷+硫代替巴),然后再予以三个疗程的 RIC(利妥昔单抗+依托泊苷+异环磷酰胺+卡铂)和卡氮芥-硫代以及自体HSCT。主要终点是1年无进展生存期。次要终点包括自体HSCT前的总应答率和完全应答率、应答持续时间、总存活率和安全性。

无进展存活期

2015年3月30日-2018年8月3日期间,共有79名患者入选。75例患者可评估。450个计划疗程实施了319个(71%)。总体上,在入组后1年时,达到了主要终点,42名患者病情无进展(无进展存活率58%;95%CI 55-61)。 MATRix–RICE治疗后,49例(65%;95%CI 54-76)患者获得客观缓解,其中29例(39%)为完全缓解。

37例获得缓解的患者接受了自体HSCT。在方案结束时,46名患者(61%;95%CI 51-71)获得客观缓解,客观缓解中位持续时间为26个月(IQR 16-37)。中位随访29个月(IQR 20-40),35名患者病情无进展,33名存活,两年总存活率为46%(95%CI 39-53)。

不良反应

最常见的3-4级毒性是血液毒性:中性粒细胞减少(61%)、血小板减少(60%)、贫血(35%)。42名(56%)患者发生79例严重不良事件,其中4例(5%)死于革兰阴性菌败血症(治疗相关死亡率5%;95%CI 0.07-9.93)。

综上,MATRix–RICE方案联合自体HSCT用于这类预后非常差的患者的治疗活性显著,而且毒性强度可接受

原始出处:

Ferreri Andrés J M,Doorduijn Jeanette K,Re Alessandro et al. MATRix-RICE therapy and autologous haematopoietic stem-cell transplantation in diffuse large B-cell lymphoma with secondary CNS involvement (MARIETTA): an international, single-arm, phase 2 trial. Lancet Haematol, 2021, 8: e110-e121.

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    2021-05-20 howi
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    2021-10-08 lg.zhao
  4. 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level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11328, encryptionId=9613113283e, topicName=MATRix)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ced3193, createdName=freve, createdTime=Fri Jul 02 02:27:02 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1724536, encodeId=6e2b1e2453661, content=<a href='/topic/show?id=78ece8958b2' target=_blank style='color:#2F92EE;'>#继发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78958, encryptionId=78ece8958b2, topicName=继发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=499d33645837, createdName=feifers, createdTime=Sun Feb 14 20:27:02 CST 2021, time=2021-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1273384, encodeId=5bb812e338414, content=<a href='/topic/show?id=310d383ef5' target=_blank style='color:#2F92EE;'>#B细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3837, encryptionId=310d383ef5, topicName=B细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6eba113, createdName=xiaoyeshuang, createdTime=Tue Feb 09 02:27:02 CST 2021, time=2021-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1317615, encodeId=85a8131e6156e, content=<a href='/topic/show?id=74916e0414' target=_blank style='color:#2F92EE;'>#EMA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6704, encryptionId=74916e0414, topicName=EMA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35a460, createdName=fengyi812, createdTime=Tue Feb 09 02:27:02 CST 2021, time=2021-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578436, encodeId=874215e8436ac, content=<a href='/topic/show?id=cabf914424' target=_blank style='color:#2F92EE;'>#HSCT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9144, encryptionId=cabf914424, topicName=HSCT)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0df016405434, createdName=ms691033630344116, createdTime=Tue Feb 09 02:27:02 CST 2021, time=2021-02-09, status=1, ipAttribution=)]
    2021-08-11 sjq035
  5. [GetPortalCommentsPageByObjectIdResponse(id=1831011, encodeId=8e5418310113b, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Thu May 20 17:27:02 CST 2021, time=2021-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1702666, encodeId=d3c11e0266666, content=<a href='/topic/show?id=ddc9e795159' target=_blank style='color:#2F92EE;'>#细胞淋巴瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77951, encryptionId=ddc9e795159, topicName=细胞淋巴瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, 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href='/topic/show?id=310d383ef5' target=_blank style='color:#2F92EE;'>#B细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3837, encryptionId=310d383ef5, topicName=B细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6eba113, createdName=xiaoyeshuang, createdTime=Tue Feb 09 02:27:02 CST 2021, time=2021-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1317615, encodeId=85a8131e6156e, content=<a href='/topic/show?id=74916e0414' target=_blank style='color:#2F92EE;'>#EMA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6704, encryptionId=74916e0414, topicName=EMA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35a460, createdName=fengyi812, createdTime=Tue Feb 09 02:27:02 CST 2021, time=2021-02-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578436, encodeId=874215e8436ac, content=<a href='/topic/show?id=cabf914424' target=_blank style='color:#2F92EE;'>#HSCT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9144, encryptionId=cabf914424, topicName=HSCT)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0df016405434, createdName=ms691033630344116, createdTime=Tue Feb 09 02:27:02 CST 2021, time=2021-02-09, status=1, ipAttribution=)]
    2021-05-07 changfy
  6. [GetPortalCommentsPageByObjectIdResponse(id=1831011, encodeId=8e5418310113b, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Thu May 20 17:27:02 CST 2021, time=2021-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1702666, encodeId=d3c11e0266666, content=<a href='/topic/show?id=ddc9e795159' target=_blank style='color:#2F92EE;'>#细胞淋巴瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77951, encryptionId=ddc9e795159, topicName=细胞淋巴瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578436, encodeId=874215e8436ac, content=<a href='/topic/show?id=cabf914424' target=_blank style='color:#2F92EE;'>#HSCT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9144, encryptionId=cabf914424, topicName=HSCT)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0df016405434, createdName=ms691033630344116, createdTime=Tue Feb 09 02:27:02 CST 2021, time=2021-02-09, status=1, ipAttribution=)]
    2021-07-02 freve
  7. [GetPortalCommentsPageByObjectIdResponse(id=1831011, encodeId=8e5418310113b, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Thu May 20 17:27:02 CST 2021, time=2021-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1702666, encodeId=d3c11e0266666, content=<a href='/topic/show?id=ddc9e795159' target=_blank style='color:#2F92EE;'>#细胞淋巴瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77951, encryptionId=ddc9e795159, topicName=细胞淋巴瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578436, encodeId=874215e8436ac, content=<a href='/topic/show?id=cabf914424' target=_blank style='color:#2F92EE;'>#HSCT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9144, encryptionId=cabf914424, topicName=HSCT)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0df016405434, createdName=ms691033630344116, createdTime=Tue Feb 09 02:27:02 CST 2021, time=2021-02-09, status=1, ipAttribution=)]
    2021-02-14 feifers
  8. 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  9. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578436, encodeId=874215e8436ac, content=<a href='/topic/show?id=cabf914424' target=_blank style='color:#2F92EE;'>#HSCT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9144, encryptionId=cabf914424, topicName=HSCT)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0df016405434, createdName=ms691033630344116, createdTime=Tue Feb 09 02:27:02 CST 2021, time=2021-02-09, status=1, ipAttribution=)]
    2021-02-09 fengyi812
  10. 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