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泽布替尼治疗弥漫性大B细胞淋巴瘤方案的初步评估及泽布替尼在脑脊液中的分布:13例病例系列研究

Preliminary Evaluation of Zanubrutinib-Containing Regimens in DLBCL and the Cerebrospinal Fluid Distribution of Zanubrutinib: A 13-Case Series.

作者信息

Zhang Yan, Li Yanan, Zhuang Zhe, Wang Wei, Wei Chong, Zhao Danqing, Zhou Daobin, Zhang Wei

机构信息

Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, Beijing, China.

出版信息

Front Oncol. 2021 Dec 24;11:760405. doi: 10.3389/fonc.2021.760405. eCollection 2021.

Abstract

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.

摘要

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a4f4/8739956/605263d86bd6/fonc-11-760405-g001.jpg

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