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HAEMATOLOGICA：利妥昔单抗联合基于 LMB 的化疗方案治疗儿童和青少年原发性纵隔大 B 细胞淋巴瘤取得出色的生存率

2022-03-17 网络 网络

利妥昔单抗 LMB原发性纵隔大 B 细胞淋巴瘤
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强化LMB为基础的化疗加利妥昔单抗在儿童/青少年PMLBL患者中获得了良好的生存率，目前仍需要进一步的国际前瞻性研究来证实这一人群中的这些结果。

原发性纵隔大 B 细胞淋巴瘤 (PMLBL) 是一种罕见的疾病，主要影响青少年和年轻人。最近，在儿童患者中使用剂量调整后的依托泊苷、多柔比星和环磷酰胺联合长春新碱和强的松加利妥昔单抗 (DA-EPOCH-R) 的国际 2 期试验未能重现一些成人研究中报告的出色生存率。因此需要确定该疾病的最佳治疗方案。

一项法国前瞻性 LMB2001 试验里，包括了在法国中心接受治疗的所有年龄小于 18 岁的成熟 B 细胞淋巴瘤患者。对于 PMLBL 患者，治疗包括 4 至 8 个疗程的以 Lymphomes Malins B (LMB) 为基础的化疗而不进行放疗。从 2008 年开始，在每个化疗疗程之前添加了利妥昔单抗。


图1：KaplanMeier估计总生存生存和无事件生存。EFS，无事件生存率；OS，总生存率垂直线代表Rothman95%置信区间

从2001年9月到2012年3月，研究登记了 42 名 PMLBL 患者，中位年龄为 15 岁（范围 8-18 岁），21例患者接受化疗加利妥昔单抗治疗。中位随访时间为 7.1 年（四分位距，5.8-11.1）。5年无事件(EFS)和总生存率(OS)分别为88.1%(95%可信区间(CI)， 75.0%-94.8%)和95.2% (95%CI, 84.0%-98.7%)。

图2：KaplanMeier根据利妥昔单抗给药面板A估计的无事件生存期和总生存期，代表无事件生存期。面板B代表总生存率。竖线代表罗斯曼的95%置信区间

未使用利妥昔单抗和使用利妥昔单抗的患者的5年EFS分别为81.0% (95%CI, 60.0%-92.3%)和95.2% (95%CI, 77.3%-99.2%) (HR=0.24 (95%CI, 0.03-2.2))， 5年OS分别为90.5% (95%CI, 71.1%-97.3%)和100%。

仅 1/21 接受利妥昔单抗和基于 LMB 的化疗的患者出现局部早期治疗失败，但二线化疗和放疗延长了完全缓解期。总的来说，强化LMB为基础的化疗加利妥昔单抗在儿童/青少年PMLBL患者中获得了良好的生存率，需要进一步的前瞻性和国际试验来证实这些结果，并确定对PMLBL患者（包括所有年龄段）的最佳治疗方法。接下来可能需要新的药物(例如NF-kB通路抑制剂或抗pd1治疗联合或不联合本妥昔单抗-维多汀)来降低化疗强度和改善这一人群的预后。

 

原始出处：

Dourthe ME, Phulpin A, Auperin A, Bosq J, Couec M-L, Dartigues P, Ducassou S, Garnier N, Haouy S, Leblanc T, Leruste A, Paillard C, Rigaud C, Simonin M, Patte C, Minard-Colin V. Rituximab in addition to LMB-based chemotherapy regimen in children and adolescents with primary mediastinal large B-cell lymphoma: results of the French LMB2001 prospective study. Haematologica; https://doi.org/10.3324/haematol.2021.280257 [Early view].

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    2023-01-13 花花1374

    #利妥昔#

    0

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    2022-12-22 lifestar

    #儿童和青少年#

    0

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    2022-10-09 jiyangfei

    #原发性#

    0

  4. 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level=null, likeNumber=220, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Thu Mar 17 18:06:47 CST 2022, time=2022-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1203513, encodeId=afd6120351330, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=223, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/0391651C5784486DC064FF0CC8D8CF2C/100, createdBy=df4d2418589, createdName=高寒, createdTime=Thu Mar 17 17:24:54 CST 2022, time=2022-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256885, encodeId=5b8b12568859c, content=<a href='/topic/show?id=43706900963' target=_blank style='color:#2F92EE;'>#生存率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=215, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69009, encryptionId=43706900963, topicName=生存率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a6043, createdName=guoyibin, createdTime=Thu Mar 17 09:09:38 CST 2022, time=2022-03-17, status=1, ipAttribution=)]
    2022-04-17 changfy

    #HAE#

    0

  5. 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level=null, likeNumber=220, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Thu Mar 17 18:06:47 CST 2022, time=2022-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1203513, encodeId=afd6120351330, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=223, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/0391651C5784486DC064FF0CC8D8CF2C/100, createdBy=df4d2418589, createdName=高寒, createdTime=Thu Mar 17 17:24:54 CST 2022, time=2022-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256885, encodeId=5b8b12568859c, content=<a href='/topic/show?id=43706900963' target=_blank style='color:#2F92EE;'>#生存率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=215, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69009, encryptionId=43706900963, topicName=生存率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a6043, createdName=guoyibin, createdTime=Thu Mar 17 09:09:38 CST 2022, time=2022-03-17, status=1, ipAttribution=)]
    2022-10-14 marlenexl

    #细胞淋巴瘤#

    0

  6. 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href='/topic/show?id=43706900963' target=_blank style='color:#2F92EE;'>#生存率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=215, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69009, encryptionId=43706900963, topicName=生存率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a6043, createdName=guoyibin, createdTime=Thu Mar 17 09:09:38 CST 2022, time=2022-03-17, status=1, ipAttribution=)]
    2022-03-18 ms3035926579531214

    学习了，对治疗儿童特应性皮炎又有了新的方法

    0

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level=null, likeNumber=220, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Thu Mar 17 18:06:47 CST 2022, time=2022-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1203513, encodeId=afd6120351330, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=223, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/0391651C5784486DC064FF0CC8D8CF2C/100, createdBy=df4d2418589, createdName=高寒, createdTime=Thu Mar 17 17:24:54 CST 2022, time=2022-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256885, encodeId=5b8b12568859c, content=<a href='/topic/show?id=43706900963' target=_blank style='color:#2F92EE;'>#生存率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=215, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69009, encryptionId=43706900963, topicName=生存率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a6043, createdName=guoyibin, createdTime=Thu Mar 17 09:09:38 CST 2022, time=2022-03-17, status=1, ipAttribution=)]
    2022-03-17 枢筋寰骨

    学习

    0

  8. 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href='/topic/show?id=43706900963' target=_blank style='color:#2F92EE;'>#生存率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=215, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69009, encryptionId=43706900963, topicName=生存率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a6043, createdName=guoyibin, createdTime=Thu Mar 17 09:09:38 CST 2022, time=2022-03-17, status=1, ipAttribution=)]
    2022-03-17 医鸣惊人

    认真学习了

    0

  9. 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level=null, likeNumber=220, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Thu Mar 17 18:06:47 CST 2022, time=2022-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1203513, encodeId=afd6120351330, content=学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=223, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/0391651C5784486DC064FF0CC8D8CF2C/100, createdBy=df4d2418589, createdName=高寒, createdTime=Thu Mar 17 17:24:54 CST 2022, time=2022-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256885, encodeId=5b8b12568859c, content=<a 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    2022-03-17 高寒

    学习学习

    0

  10. 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href='/topic/show?id=43706900963' target=_blank style='color:#2F92EE;'>#生存率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=215, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69009, encryptionId=43706900963, topicName=生存率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a6043, createdName=guoyibin, createdTime=Thu Mar 17 09:09:38 CST 2022, time=2022-03-17, status=1, ipAttribution=)]
    2022-03-17 guoyibin

    #生存率#

    0

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Neurology：利妥昔单抗治疗乙酰胆碱受体抗体阳性重症肌无力的2期试验：安全、耐受性良好，但不可显著减少类固醇使用

虽然利妥昔单抗是安全的，耐受性良好，但这些结果表明，在轻度-中度症状AChR-Ab+GMG的3期试验中，在12个月内观察到明确的有临床意义的类固醇减量效果的可能性很低。

JNNP:厄瓜利珠单抗与利妥昔单抗治疗全身性重症肌无力的比较

重症肌无力（MG）是影响神经肌肉接头的最常见的自身免疫性疾病，其特征是抗体（ab）介导的突触后膜功能障碍。MG的特征是眼部、延髓、四肢和呼吸肌的波动性无力，并伴有相应的发病率和死亡率。在大多数MG患者

病例分享：寒冷竟也可以诱发荨麻疹？

寒冷诱发荨麻疹是因为：冷球蛋白是在低于37℃的温度下沉淀的免疫球蛋白，会导致血管闭塞，有时会导致免疫复合物血管炎和组织损伤。

BJD：超小剂量利妥昔单抗治疗天疱疮

利妥昔单抗是一种与B细胞淋巴细胞上表达的CD-20抗原结合的单克隆抗体。它通过耗尽与其结合的B细胞，减少破坏性抗体的产生，显示出治疗天疱疮的疗效。

拓展阅读

《新英格兰杂志》：利妥昔单抗与奥瑞珠单抗在新诊断的复发缓解型多发性硬化症中的对比研究

对于新诊断的复发缓解型多发性硬化症患者，利妥昔单抗在抑制磁共振成像疾病活动方面不劣于奥瑞珠单抗，且两组的严重不良事件发生率相似。

【协和医学杂志】糖皮质激素联合环磷酰胺与利妥昔单抗治疗老年ANCA相关性血管炎伴肾损害：单中心回顾性研究

本研究通过单中心回顾性队列分析，旨在探讨糖皮质激素联合 CTX与RTX方案，相较于传统糖皮质激素联合 CTX方案，在老年新发ANCA相关性血管炎伴肾损害患者中的疗效与安全性。

【协和医学杂志】利妥昔单抗生物类似药临床使用情况分析：单中心回顾性研究

鉴于国内使用的利妥昔单抗生物类似药以利妥昔单抗注射液为主，故本研究统计该药在临床中的使用情况、超说明书用药情况、不良反应等，分析其用药证据水平及与原研药相比的经济性，以期为临床用药提供参考。

利妥昔单抗每 12 个月 vs 6 个月给药治疗稳定期复发性多发性硬化症的疗效与安全性：基于目标试验模拟的真实世界研究

本研究表明，对于RTX治疗一年后达到疾病稳定的RMS患者——包括那些起始时病情高度活跃者——将给药间隔延长至每12个月并未显著增加疾病活动风险，且可大幅降低累积剂量，有望减少感染及相关医疗成本。

大样本研究证实套细胞淋巴瘤一线BR治疗后利妥昔单抗维持治疗有获益

学者开展了大样本回顾性研究，以探索MCL一线BR治疗后利妥昔单抗维持治疗的疗效。

EClinicalMedicine：基于PLA2R1表位扩散的个体化利妥昔单抗治疗改善膜性肾病临床缓解率

基于PLA2R1表位扩散状态的个体化利妥昔单抗治疗方案显著提高膜性肾病患者12个月临床缓解率，且肾功能改善明显，无增加不良事件风险。

2023 中国临床实践指南：利妥昔单抗治疗儿童激素敏感性肾病综合征（英文版）

中国医师协会儿科医师分会 · 2025-08-13

利妥昔单抗超说明书用药专家共识

暂未更新 · 2024-08-28

利妥昔单抗注射液生物类似药临床试验指导原则

国家药品监督管理局药品审评中心（CDE） · 2020-07-20

利妥昔单抗在儿童激素敏感型肾病综合征中应用临床实践指南

暂未更新 · 2023-08-25

奥斯卡临床医疗指南：利妥昔单抗（Rituximab）治疗多发性硬化症和重症肌无力症(CG055)

奥斯卡 Oscar · 2022-09-15

2022 GISC循证共识建议：利妥昔单抗治疗混合性冷球蛋白血症

意大利冷球蛋白血症研究组(GISC,Italian Study Group of Cryoglobulinemia) · 2022-09-28