本妥昔单抗维迪西妥单抗联合苯达莫司汀:复发或难治性霍奇金淋巴瘤的高效一线挽救治疗方案。

Brentuximab vedotin plus bendamustine: a highly active first salvage regimen for relapsed or refractory Hodgkin lymphoma.

机构信息

Dana-Farber Cancer Institute, Boston, MA.

Division of Oncology & Hematology, University of Nebraska Medical Center, Omaha, NE.

出版信息

Blood. 2018 Jul 5;132(1):40-48. doi: 10.1182/blood-2017-11-815183. Epub 2018 Apr 27.

Abstract

Autologous stem cell transplantation (ASCT) is standard of care for patients with Hodgkin lymphoma (HL) who have relapsed/refractory disease after frontline chemotherapy. Achievement of complete remission (CR) with pre-ASCT salvage chemotherapy predicts favorable outcomes post-ASCT. This phase 1/2 study evaluated the combination of brentuximab vedotin (BV) plus bendamustine as a first salvage regimen in relapsed/refractory HL. A total of 55 patients (28 primary refractory and 27 relapsed) were enrolled. Patients received BV (1.8 mg/kg) on day 1 and bendamustine (90 mg/m) on days 1 and 2 of a 21-day cycle for up to 6 cycles. Patients could undergo ASCT any time after cycle 2. Following ASCT or completion of combination therapy if not proceeding to ASCT, patients could receive BV monotherapy for up to 16 cycles of total therapy. After a median of 2 cycles of combination therapy (range, 1-6), the objective response rate among 53 efficacy-evaluable patients was 92.5%, with 39 patients (73.6%) achieving CR. Forty patients underwent ASCT. Thirty-one patients (25 of whom underwent ASCT) received BV monotherapy (median, 10 cycles; range, 1-14). After a median of 20.9 months of follow-up, the estimated 2-year progression-free survival was 69.8% and 62.6% for patients who received ASCT and all patients, respectively. Thirty-one patients (56.4%) experienced infusion-related reactions (IRRs), with a majority occurring during cycle 2 of combination therapy. A protocol amendment requiring premedication reduced IRR severity. BV plus bendamustine as first salvage therapy in relapsed/refractory HL is highly active with a manageable toxicity profile. This trial was registered at www.clinicaltrials.gov as #NCT01874054.

摘要

自体干细胞移植(ASCT)是一线化疗后复发/难治性霍奇金淋巴瘤(HL)患者的标准治疗方法。ASCT 前挽救性化疗达到完全缓解(CR)预测 ASCT 后预后良好。这项 1/2 期研究评估了 brentuximab vedotin(BV)联合苯达莫司汀作为复发/难治性 HL 的一线挽救方案。共纳入 55 例患者(28 例原发耐药,27 例复发)。患者接受 BV(1.8mg/kg)于第 1 天和苯达莫司汀(90mg/m)于第 1 和 2 天,每 21 天为 1 个周期,最多 6 个周期。患者可在第 2 个周期后随时进行 ASCT。ASCT 后或组合治疗完成后(如果不进行 ASCT),患者可接受 BV 单药治疗,最多可达 16 个周期的总治疗。在联合治疗 2 个周期的中位数后(范围 1-6),53 例可评估疗效的患者的客观缓解率为 92.5%,39 例(73.6%)达到 CR。40 例患者接受了 ASCT。31 例患者(其中 25 例接受 ASCT)接受了 BV 单药治疗(中位数,10 个周期;范围,1-14)。在中位数为 20.9 个月的随访后,接受 ASCT 和所有患者的 2 年无进展生存率分别为 69.8%和 62.6%。31 例患者(56.4%)发生了输液相关反应(IRR),大多数发生在联合治疗的第 2 个周期。修订方案要求进行预处理减少了 IRR 的严重程度。BV 联合苯达莫司汀作为复发/难治性 HL 的一线挽救治疗具有高度活性和可控的毒性特征。这项试验在 www.clinicaltrials.gov 上注册,编号为 #NCT01874054。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a5ab/6073588/69f2ae995538/blood815183absf1.jpg

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