非生发中心 B 细胞样弥漫大 B 细胞淋巴瘤对来那度胺的反应高于生发中心 B 细胞样表型。

Higher response to lenalidomide in relapsed/refractory diffuse large B-cell lymphoma in nongerminal center B-cell-like than in germinal center B-cell-like phenotype.

机构信息

Department of Medical Oncology and Immunology, Roswell Park Cancer Institute, Buffalo, New York, USA.

出版信息

Cancer. 2011 Nov 15;117(22):5058-66. doi: 10.1002/cncr.26135. Epub 2011 Apr 14.

DOI:10.1002/cncr.26135

PMID:21495023

Abstract

BACKGROUND

There is a need to develop novel therapies for relapsed/refractory diffuse large B-cell lymphoma (DLBCL) and to identify biomarkers predictive for therapeutic response. Lenalidomide was previously shown to induce an overall response rate (ORR) of 28% in patients with relapsed/refractory DLBCL. It is currently unknown if response rates differ between patients with different DLBCL subtypes.

METHODS

The authors retrospectively evaluated clinical outcomes of patients with germinal center B-cell-like versus nongerminal center B-cell-like DLBCL treated with salvage lenalidomide at 4 academic institutions.

RESULTS

Forty patients with relapsed/refractory DLBCL were included (24 men; 16 women; median age, 66 years; median of 4 prior treatments, including rituximab chemotherapy). Patients were classified as germinal center B-cell-like (n = 23) or nongerminal center B-cell-like (n = 17) DLBCL according to the Hans algorithm. The subgroups were similar in terms of stage, international prognostic index score, prior number of treatments, and rituximab resistance. A significant difference in clinical response to lenalidomide was observed in nongerminal center B-cell-like versus germinal center B-cell-like patients. ORR was 52.9% versus 8.7% (P = .006); complete response rate was 23.5% versus 4.3%. Median progression-free survival was 6.2 versus 1.7 months (P = .004), although no difference in OS was observed between nongerminal center B-cell-like and germinal center B-cell-like DLBCL patients.

CONCLUSIONS

The data suggest that the 2 major subgroups of patients with DLBCL (germinal center B cell and nongerminal center B cell) have different antitumor responsiveness to lenalidomide in the relapsed/refractory setting. A large international trial (NCT01197560) has been opened to enrollment in an attempt to prospectively validate these retrospective observations.

摘要

背景

需要开发新的疗法来治疗复发/难治性弥漫性大 B 细胞淋巴瘤 (DLBCL)，并确定预测治疗反应的生物标志物。来那度胺先前已显示在复发/难治性 DLBCL 患者中诱导总缓解率 (ORR) 为 28%。目前尚不清楚不同 DLBCL 亚型患者的反应率是否存在差异。

方法

作者回顾性评估了在 4 个学术机构接受挽救性来那度胺治疗的生发中心 B 细胞样与非生发中心 B 细胞样 DLBCL 患者的临床结局。

结果

共纳入 40 例复发/难治性 DLBCL 患者（24 例男性；16 例女性；中位年龄 66 岁；中位接受过 4 种治疗，包括利妥昔单抗化疗）。根据 Hans 算法，患者被分为生发中心 B 细胞样（n = 23）或非生发中心 B 细胞样（n = 17）DLBCL。两组在分期、国际预后指数评分、既往治疗次数和利妥昔单抗耐药方面相似。非生发中心 B 细胞样与生发中心 B 细胞样患者接受来那度胺治疗的临床反应存在显著差异。ORR 分别为 52.9%和 8.7%（P =.006）；完全缓解率分别为 23.5%和 4.3%。中位无进展生存期分别为 6.2 个月和 1.7 个月（P =.004），但非生发中心 B 细胞样和生发中心 B 细胞样 DLBCL 患者的总生存期无差异。