Zhang Yan, Li Yanan, Zhuang Zhe, Wang Wei, Wei Chong, Zhao Danqing, Zhou Daobin, Zhang Wei
Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, Beijing, China.
Front Oncol. 2021 Dec 24;11:760405. doi: 10.3389/fonc.2021.760405. eCollection 2021.
Zanubrutinib is a second-generation Bruton's tyrosine kinase inhibitor. Its safety and effectiveness in central nervous system (CNS) lymphoma along with its distribution in the brain and ability to cross the blood-brain barrier (BBB) remain unknown. This retrospective case series involved patients with diffuse large B-cell lymphoma (DLBCL) treated with zanubrutinib-containing regimens from August to December 2020 in PUMCH. The amounts of zanubrutinib in the plasma and brain were assessed by liquid chromatography-tandem mass spectrometry in paired plasma and cerebrospinal fluid (CSF) samples. In total, 13 patients were included: eight primary CNS lymphoma cases and five systemic DLBCL cases with 61.5% (8/13) refractory/relapsed and 84.6% (11/13) showing CNS involvement. The overall response rates were 84.5% in the entire population and 81.8% in the CNS-involved cases. A total of 23 time-matched plasma-CSF sample pairs were collected. The mean peak concentration of zanubrutinib in CSF was 2941.1 pg/ml (range, 466-9032.0 pg/ml). The corrected mean CSF/plasma ratio determined based on 94% protein binding was 42.7% ± 27.7% (range, 8.6%-106.3%). This preliminary study revealed the effectiveness of zanubrutinib-containing regimens in DLBLC, especially CNS-involved cases, for the first time. The excellent BBB penetration of zanubrutinib supports its further investigation for the treatment of CNS lymphoma.
泽布替尼是第二代布鲁顿酪氨酸激酶抑制剂。其在中枢神经系统(CNS)淋巴瘤中的安全性和有效性,以及在脑内的分布和穿越血脑屏障(BBB)的能力尚不清楚。本回顾性病例系列研究纳入了2020年8月至12月在北京协和医院接受含泽布替尼方案治疗的弥漫性大B细胞淋巴瘤(DLBCL)患者。通过液相色谱-串联质谱法对配对的血浆和脑脊液(CSF)样本中的泽布替尼含量进行评估。总共纳入了13例患者:8例原发性CNS淋巴瘤病例和5例系统性DLBCL病例,其中61.5%(8/13)为难治性/复发性病例,84.6%(11/13)有CNS受累。总体缓解率在全部患者中为84.5%,在有CNS受累的病例中为81.8%。共收集了23对时间匹配的血浆-CSF样本对。泽布替尼在CSF中的平均峰值浓度为2941.1 pg/ml(范围为466 - 9032.0 pg/ml)。基于94%的蛋白结合率计算得出的校正后平均CSF/血浆比值为42.7% ± 27.7%(范围为8.6% - 106.3%)。这项初步研究首次揭示了含泽布替尼方案在DLBLC,尤其是有CNS受累病例中的有效性。泽布替尼出色的血脑屏障穿透能力支持其进一步用于治疗CNS淋巴瘤的研究。