Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Ann Hematol. 2022 Feb;101(2):349-358. doi: 10.1007/s00277-021-04711-9. Epub 2021 Nov 11.
Polatuzumab vedotin (PoV) has recently shown promising activity when combined with rituximab-bendamustine (BR) in patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). However, few studies have described the prognostic factors predicting response. Here, we aimed to evaluate the efficacy and safety profile of PoV-based chemotherapy, including regimens other than BR, as third-line or beyond treatment for patients with R/R DLBCL and to explore prognostic factors. Overall, 40 patients, including 37 with de novo and 3 with transformed DLBCL, were enrolled. The overall response rate was 52.5%, and 25% and 27.5% of patients showed a complete response and partial response, respectively. With a median follow-up of 18.8 months, the median overall survival (OS) of the total cohort was 8.5 months, and that of those receiving subsequent hematopoietic stem cell transplantation (HSCT) was 24 months. Low/intermediate risk according to the revised International Prognostic Index score at diagnosis and before PoV treatment predicted better OS. Furthermore, a normal lactate dehydrogenase level and an absolute lymphocyte count/absolute monocyte count ratio > 1.5 were favorable OS prognostic factors. The most common adverse event was cytopenia, with 42.5% of patients developing febrile neutropenia. Grade 1-3 peripheral neuropathy associated with PoV was reported in 25% of patients and resolved in most patients after the cessation of treatment. In summary, we demonstrated that PoV combined with either BR or other intensive chemotherapy is an effective and well-tolerated salvage option for patients with R/R DLBCL. Subsequent HSCT has the potential to further improve survival outcomes in this high-risk population. Clinicaltrials.gov number: NCT05006534.
波拉妥珠单抗(PoV)与利妥昔单抗-苯达莫司汀(BR)联合治疗复发/难治性(R/R)弥漫性大 B 细胞淋巴瘤(DLBCL)患者时显示出有前景的活性。然而,很少有研究描述预测反应的预后因素。在此,我们旨在评估基于 PoV 的化疗方案的疗效和安全性,包括 BR 以外的方案,作为 R/R DLBCL 的三线或以上治疗,并探讨预后因素。总体而言,共纳入 40 例患者,其中 37 例为初发,3 例为转化型 DLBCL。总体缓解率为 52.5%,完全缓解率和部分缓解率分别为 25%和 27.5%。中位随访 18.8 个月,总队列的中位总生存期(OS)为 8.5 个月,接受后续造血干细胞移植(HSCT)的患者为 24 个月。诊断时和 PoV 治疗前根据修订的国际预后指数评分评估的低/中危提示 OS 更好。此外,乳酸脱氢酶水平正常和绝对淋巴细胞计数/绝对单核细胞计数比值>1.5 是 OS 的有利预后因素。最常见的不良反应是血细胞减少症,42.5%的患者发生发热性中性粒细胞减少症。25%的患者报告了与 PoV 相关的 1-3 级周围神经病变,大多数患者在停止治疗后得到缓解。总之,我们证实,PoV 联合 BR 或其他强化化疗是 R/R DLBCL 患者有效且耐受良好的挽救治疗选择。在该高危人群中,后续的 HSCT 有可能进一步改善生存结局。临床试验注册号:NCT05006534。
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