Novakovic Aleksander, Boltezar Lucka, Novakovic Barbara Jezersek
Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia.
Department of Lymphoma Treatment, Division of Medical Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia.
Oncol Lett. 2020 Mar;19(3):2028-2034. doi: 10.3892/ol.2020.11288. Epub 2020 Jan 10.
Relapsed or refractory diffuse large B-cell lymphoma (DLBCL) is an aggressive disease with poor outcomes in patients ineligible for autologous stem cell transplantation. In this setting, novel treatment approaches are urgently required and the innovative agent pixantrone has shown some promising results in terms of disease-free and overall survival (OS). The present study retrospectively analyzed 12 patients routinely treated with pixantrone in monotherapy or in combinations at the Institute of Oncology Ljubljana, Slovenia, between January 2016 and October 2018. All 12 patients had refractory lymphoma to last treatment and a large proportion of them had other high risk features (high proliferation index, high disease stage, high international prognostic index (IPI) score, high percentage of primary refractory disease and high percentage of refractoriness to anthracyclines) at initiation of pixantrone. All patients progressed during treatment and none of the patients were alive at the time of analysis due to progressive lymphoma. Pixantrone specific median OS was 3.5 months (range, 0.5-10 months). A somewhat superior median OS (P=0.065) was observed in patients primarily sensitive to anthracyclines. Pixantrone has shown only limited efficacy in the present real world study comparable to the results of another real world UK retrospective analysis and substantially worse than the efficacy observed in the PIX301 registration trial. Therefore, an appropriate selection of patients for this treatment is crucial. Despite the limited experience due to a small number of patients, it was recommended to consider only patients with relapsed (and not refractory) disease, patients with non-primary refractory disease and those with fewer lines of prior therapy.
复发或难治性弥漫性大B细胞淋巴瘤（DLBCL）是一种侵袭性疾病，对于不符合自体干细胞移植条件的患者，其预后较差。在这种情况下，迫切需要新的治疗方法，创新药物匹杉琼在无病生存期和总生存期（OS）方面已显示出一些有前景的结果。本研究回顾性分析了2016年1月至2018年10月期间在斯洛文尼亚卢布尔雅那肿瘤研究所接受匹杉琼单药治疗或联合治疗的12例患者。所有12例患者对最后一次治疗均为难治性淋巴瘤，并且其中很大一部分患者在开始使用匹杉琼时具有其他高风险特征（高增殖指数、高疾病分期、高国际预后指数（IPI）评分、原发性难治性疾病的高比例以及对蒽环类药物难治性的高比例）。所有患者在治疗期间均病情进展，由于淋巴瘤进展，在分析时没有患者存活。匹杉琼特定的中位总生存期为3.5个月（范围为0.5 - 10个月）。在对蒽环类药物主要敏感的患者中观察到中位总生存期略长（P = 0.065）。在本项真实世界研究中，匹杉琼仅显示出有限的疗效，这与另一项英国真实世界回顾性分析的结果相当，且远低于在PIX301注册试验中观察到的疗效。因此，为这种治疗方法恰当选择患者至关重要。尽管由于患者数量少导致经验有限，但建议仅考虑复发（而非难治性）疾病患者、非原发性难治性疾病患者以及既往治疗线数较少的患者。
