Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Hematol Oncol. 2021 Oct;39(4):465-472. doi: 10.1002/hon.2871. Epub 2021 May 2.
Bendamusutine plus rituximab (BR) regimen is one of the standard regimens for indolent B-cell lymphomas, yet the possibility of reduction of cycles of BR therapy without compromising therapeutic effects is not still uncovered. We retrospectively surveyed 57 cases including 40 follicular lymphoma cases who underwent BR regimen in our institute. The overall response (OR) rate and complete response (CR) rate were 86.0% (95% confidential interval (CI), 74.2-93.7) and 54.4% (40.7-67.6), respectively. Five-year overall survival (OS) and 5-years progression-free survival (PFS) were 76.8% and 45.7%, respectively. We then grouped the patients by the number of administered cycles of BR regimen. PFS was significantly longer in 41 cases of the later cessation group (cycle 4-6) than in 16 cases of the earlier cessation group (cycle 1-3) (p = 0.012, 5-years PFS; 46.8% vs. 35.2%, respectively), and both of OR and CR rate of the former was better than the latter (OR rate; 95.1% vs. 62.5%, p < 0.01, CR rate; 61.4% vs. 31.3%, p = 0.04). Interestingly PFS of twenty-one (36.8%) cases receiving just 4 cycles was longer than that of 20 cases who received five or 6 cycles (p < 0.01, 5-years PFS; 71.8% vs. 23.2%, respectively). Focusing on the group of four cycles, the 12 case with CR revealed longer PFS than seven cases with partial response (PR), and median PFS was not reached in CR cases and 16.9 months in the PR cases (p < 0.01). These results suggest that four cycles at least should be administered if possible, and the outcome of the patients who discontinued BR after four cycles was not inferior to that of the cases who received five or six cycles. In conclusion, discontinuation after four cycles may be permissible in some cases with complete response to BR regimen.
苯达莫司汀联合利妥昔单抗（BR）方案是惰性 B 细胞淋巴瘤的标准方案之一，但尚未发现减少 BR 治疗周期而不影响治疗效果的可能性。我们回顾性调查了 57 例在我院接受 BR 方案治疗的患者，包括 40 例滤泡性淋巴瘤患者。总缓解率（OR）和完全缓解率（CR）分别为 86.0%（95%可信区间（CI），74.2-93.7）和 54.4%（40.7-67.6）。5 年总生存率（OS）和 5 年无进展生存率（PFS）分别为 76.8%和 45.7%。然后，我们根据 BR 方案治疗周期的数量将患者分组。在停止治疗 4-6 个周期的 41 例患者中，PFS 明显长于停止治疗 1-3 个周期的 16 例患者（p=0.012，5 年 PFS；46.8% vs. 35.2%），且前者的 OR 率和 CR 率均优于后者（OR 率；95.1% vs. 62.5%，p<0.01，CR 率；61.4% vs. 31.3%，p=0.04）。有趣的是，接受 4 个周期治疗的 21 例（36.8%）患者的 PFS 长于接受 5 个或 6 个周期治疗的 20 例患者（p<0.01，5 年 PFS；71.8% vs. 23.2%）。在接受 4 个周期治疗的患者中，12 例 CR 患者的 PFS 长于 7 例 PR 患者，且 CR 患者的中位 PFS 未达到，而 PR 患者的中位 PFS 为 16.9 个月（p<0.01）。这些结果表明，如果可能，至少应给予 4 个周期的治疗，并且在 BR 方案治疗后停止治疗的患者的结局并不劣于接受 5 个或 6 个周期治疗的患者。总之，在某些对 BR 方案完全缓解的患者中，停止治疗后 4 个周期可能是可以接受的。
