Blood:Myc对采用EPOCH±Vorinostat治疗的HIV-NHLs的预后的影响

2020-06-01 QQY MedSci原创

MYC驱动的DLBCL患者经EPOCH治疗的预后较差,而vorinostat(伏立诺他)对HIV和化疗疗效无影响。 允许在基于EPOCH的化疗前进行1个周期的系统治疗可促进方案落实,且不会恶化结果。

EPOCH是HIV-NHLs的首选方案,通常为EBV+或HHV-8+。组蛋白去乙酰化酶(HDAC)抑制剂伏立诺他干扰EBV/HHV-8潜伏期,增强化疗诱导的细胞死亡,并可能能清除HIV宿主。

为了评估伏立诺他是否可增强EPOCH疗效和/或HIV清除率,研究人员开展了一项随机的2期试验,招募了90位侵袭性的HIV-NHLs患者,予以剂量校正的EPOCH(如果CD20+则联合利妥昔单抗)或EPOCH联合伏立诺他(300 mg)治疗。允许最多提前一个周期予以系统化疗。主要终点是完全缓解(CR)。

在86位可评估的弥漫性大B细胞淋巴瘤(61人)、浆母细胞性淋巴瘤(15人)、原发性积液淋巴瘤(7人)、未分类的B细胞NHL(2人)和Burkitt淋巴瘤(1人)中,EPOCH疗法和EPOCH联合伏立诺他的CR率分别是74%和68%。CD4+计数<200细胞/mm3的患者的CR率较低。

与单用EPOCH相比,EPOCH-伏立诺他并没有消除HIV宿主,而且导致了更频繁的四级中性粒细胞减少症和血小板减少症。

治疗臂的总体和无事件存活率(EFS)相近。总体上,Myc+DLBCL患者的EFS更低(3年EFS:44%;而Myc-DLBCL的为83%)。诊断-治疗间隔(DTI)短也与较差的预后相关,而协议前治疗没有负面影响。

综上所述,EPOCH对高侵袭性HIV-NHLs具有广泛的疗效,而伏立诺他没有任何益处;Myc驱动的DLBCL、低CD4和低DTI患者预后较差。

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    2020-12-19 okhuali
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    2020-06-03 guihongzh
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    2020-06-03 yzh402

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