Haematologica:CLL一线抢救治疗,BR pk 依鲁替尼

2018-08-17 吴星 环球医学

2018年7月,发表在《Haematologica》的由意大利、英国、西班牙等国学者进行的GIMEMA、ERIC和UK CLL FORUM研究,考察了苯达莫司汀和利妥昔单抗(BR)作为慢性淋巴细胞白血病(CLL)一线抢救治疗的有效性并与依鲁替尼进行间接比较。

2018年7月,发表在《Haematologica》的由意大利、英国、西班牙等国学者进行的GIMEMA、ERIC和UK CLL FORUM研究,考察了苯达莫司汀和利妥昔单抗(BR)作为慢性淋巴细胞白血病(CLL)一线抢救治疗的有效性并与依鲁替尼进行间接比较。

背景:研究者进行了一项观察性研究,调查BR作为CLL一线抢救方案的有效性。

方法和结果:在包括237名患者的意愿治疗分析中,中位无进展生存期(PFS)为25个月。多变量分析显示,存在del(17p)、未突变的IGHV和分期晚期与较短的PFS相关。开始下一次治疗的中位时间为31.3个月。多变量分析中,将化学免疫治疗方案作为前线治疗是到下次治疗时间较短的唯一预测因素。中位总生存期(OS)为74.5个月。晚期分期(即,Rai III~IV期或Binet C期)和耐药为仅有的与较短OS显著相关的参数。6.3%的患者发生3~5级感染。与依鲁替尼(英国和意大利命名病人计划中作为二线治疗)进行的配对调整间接比较,将OS作为客观终点。当将分析限制于具有完整17p且接受化学免疫治疗作为一线方案的患者时,依鲁替尼(36个月时63%存活)和BR治疗(36个月时74.14%存活)的患者的OS无差异。

结论:真实世界人群中,包括老年和不适用患者,BR是一种有效的CLL一线抢救方案。当用作无17p缺失的患者的一线抢救治疗时,BR和依鲁替尼在OS上或等效。

专家点评:国内目前已上市依鲁替尼,但针对CLL尚缺乏证据,本研究比较了BR方案与依鲁替尼,显示OS或无差异。

原始出处:

Cuneo A, Follows G, Rigolin GM, et.al. Efficacy of bendamustine and rituximab as first salvage treatment in chronic lymphocytic leukemia and indirect comparison with ibrutinib: a GIMEMA, ERIC and UK CLL FORUM study. Haematologica. 2018 Jul;103(7):1209-1217. doi: 10.3324/haematol.2018.189837. Epub 2018 Apr 19.

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    2019-04-18 changfy
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    2018-08-19 1209e435m98(暂无昵称)

    学习了,谢谢分享

    0

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    2018-08-19 fengyi812
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    2018-08-19 lfyang
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    2018-08-17 1e145228m78(暂无匿称)

    学习了,谢谢作者分享!

    0

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伴17号染色体缺失(del[17p])或TP53基因突变的慢性淋巴细胞白血病(CLL)患者预后差,Venetoclax可有效提高该类患者缓解率,但早期临床试验结果尚不能明确Venetoclax应答持久性及安全性等问题。近日,JCO杂志发布了Venetoclax治疗伴del(17p)难治复发CLL患者的最新随访结果,旨在评估Venetoclax应答持久性、安全性及患者微小残留灶(MRD)情况。