Lee Hun Ju, Romaguera Jorge E, Feng Lei, Desai Aakash P, Zhang Liang, Fanale Michelle, Samaniego Felipe, Hagemeister Fredrick B, Fayad Luis E, Rodriguez Maria A, Medeiros Jeffrey L, Hartig Kimberly, Nomie Krystle, Ahmed Makhdum, Badillo Maria, Ye Haige, Oki Yasuhiro, Lin Pei, Nastoupil Loretta, Westin Jason, Wang Michael
Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
Oncologist. 2017 May;22(5):549-553. doi: 10.1634/theoncologist.2016-0328. Epub 2017 Apr 13.
Relapsed or refractory mantle cell lymphoma (MCL) has a poor prognosis. The best outcome is achieved in patients who have a partial or complete response to salvage treatment and proceed to allogeneic stem cell transplant.
Twenty-one patients were given a combination regimen of bortezomib, cyclophosphamide, and rituximab at MD Anderson Cancer Center as part of a single-arm, prospective, open-label phase II clinical trial. The median age was 66 years, with a median number of prior treatments of three. Sixty-seven percent had failed intensive chemoimmunotherapy and 43% were intermediate/high risk according to the MCL international prognostic index score, with a median Ki-67 proliferation index of 45% in those who were tested.
The rates of overall and complete response achieved were 74% and 42%, respectively, with median progression-free and overall survivals of 9 months and 36.4 months, respectively. The regimen's toxicity profile was acceptable; only 25% of the cycles resulted in grade 3 or 4 neutropenia or thrombocytopenia, and only 3% of cycles produced grade 3-4 fatigue. There were no episodes of grade 3-4 neuropathy.
The combination of bortezomib with cyclophosphamide and rituximab is an effective and well-tolerated regimen in patients with relapsed/refractory MCL. Because of its low toxicity, future combinations of this regimen with other promising drugs that have different mechanisms of action offer a realistic possibility that may improve outcomes for patients who have MCL. 2017;22:549-553 IMPLICATIONS FOR PRACTICE: The combination of bortezomib with cyclophosphamide and rituximab represents an additional effective novel salvage regimen for mantle cell lymphoma. This combination adds to the growing list of treatment options available for patients with mantle cell lymphoma.
复发或难治性套细胞淋巴瘤（MCL）预后较差。对挽救治疗有部分或完全反应并接受异基因干细胞移植的患者预后最佳。
在MD安德森癌症中心，21例患者接受了硼替佐米、环磷酰胺和利妥昔单抗的联合方案治疗，这是一项单臂、前瞻性、开放标签的II期临床试验的一部分。中位年龄为66岁，既往治疗的中位次数为3次。67%的患者强化化疗免疫治疗失败，根据MCL国际预后指数评分，43%为中/高风险，检测患者的中位Ki-67增殖指数为45%。
总缓解率和完全缓解率分别为74%和42%，无进展生存期和总生存期的中位数分别为9个月和36.4个月。该方案的毒性特征可接受；仅25%的疗程导致3级或4级中性粒细胞减少或血小板减少，仅3%的疗程产生3 - 4级疲劳。无3 - 4级神经病变事件。
硼替佐米与环磷酰胺和利妥昔单抗联合方案对复发/难治性MCL患者是一种有效且耐受性良好的方案。由于其低毒性，该方案未来与其他具有不同作用机制的有前景药物联合使用，有可能改善MCL患者的预后。2017年；22:549 - 553对实践的启示：硼替佐米与环磷酰胺和利妥昔单抗联合是套细胞淋巴瘤又一种有效的新型挽救方案。这种联合增加了套细胞淋巴瘤患者可用治疗选择的清单。
