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在 PHOENIX 三期临床试验中,伊布替尼联合 R-CHOP 方案治疗未经治疗的同时表达 BCL2 和 MYC 的弥漫性大 B 细胞淋巴瘤的临床影响。

Clinical impact of ibrutinib plus R-CHOP in untreated DLBCL coexpressing BCL2 and MYC in the phase 3 PHOENIX trial.

机构信息

Centre for Cancer Immunology, University of Southampton, Southampton General Hospital, Southampton, United Kingdom.

Oncology Translational Research, Janssen Research & Development, San Diego, CA.

出版信息

Blood Adv. 2023 May 23;7(10):2008-2017. doi: 10.1182/bloodadvances.2022009389.


DOI:10.1182/bloodadvances.2022009389
PMID:36696540
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10188634/
Abstract

Diffuse large B-cell lymphoma (DLBCL), with high coexpression of BCL2 and MYC proteins (DE lymphoma), is considered an adverse prognostic indicator associated mostly with non-germinal center B-cell-like (non-GCB) DLBCL. BCL2/MYC overexpression is associated with B-cell receptor (BCR) pathway activation; consequently, DE DLBCL may be sensitive to BCR inhibitors. We assessed whether high BCL2/MYC coexpression by RNA sequencing could identify a patient subset responsive to ibrutinib using baseline biopsies from the PHOENIX trial, which evaluated the addition of ibrutinib to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in untreated non-GCB DLBCL. BCL2/MYC RNA expression was correlated with lower event-free survival (EFS) and overall survival (OS) using Kaplan-Meier estimates with Cox regression and log-rank testing. In total, 234 of 766 (30.5%) patients had high BCL2/MYC coexpression: 123 of 386 (31.9%) received ibrutinib plus R-CHOP and 111 of 380 (29.2%) received R-CHOP. EFS was superior with ibrutinib plus R-CHOP compared with R-CHOP alone in patients with high BCL2/MYC coexpression, but there was no significant impact on OS. However, EFS and OS showed clinically meaningful improvement with ibrutinib plus R-CHOP over R-CHOP alone in patients aged <60 years with high BCL2/MYC coexpression. We observed a significant association between high BCL2/MYC coexpression and activated B-cell-like and MYD88L265P/CD79B-mutated subtypes of DLBCL. Consequently, high BCL2/MYC coexpression identified a subset of non-GCB DLBCL that may be preferentially responsive to ibrutinib and warrants further investigation. This trial was registered at www.clinicaltrials.gov as #NCT01855750.

摘要

弥漫性大 B 细胞淋巴瘤(DLBCL),伴有 BCL2 和 MYC 蛋白的高共表达(DE 淋巴瘤),被认为是一种不良预后指标,主要与非生发中心 B 细胞样(non-GCB)DLBCL 相关。BCL2/MYC 过表达与 B 细胞受体(BCR)途径的激活有关;因此,DE DLBCL 可能对 BCR 抑制剂敏感。我们评估了通过 RNA 测序检测到的高 BCL2/MYC 共表达是否可以通过 PHOENIX 试验的基线活检来识别对伊布替尼敏感的患者亚组,该试验评估了伊布替尼联合利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松(R-CHOP)在未经治疗的 non-GCB DLBCL 中的应用。使用 Kaplan-Meier 估计和 Cox 回归及对数秩检验对 BCL2/MYC RNA 表达与无事件生存(EFS)和总生存(OS)的相关性进行了分析。在 766 例患者中,共有 234 例(30.5%)患者存在高 BCL2/MYC 共表达:其中 123 例(31.9%)接受伊布替尼联合 R-CHOP 治疗,111 例(29.2%)接受 R-CHOP 治疗。在高 BCL2/MYC 共表达患者中,与单独接受 R-CHOP 相比,伊布替尼联合 R-CHOP 可显著改善 EFS,但对 OS 无显著影响。然而,在年龄<60 岁且高 BCL2/MYC 共表达的患者中,与单独接受 R-CHOP 相比,伊布替尼联合 R-CHOP 可显著改善 EFS 和 OS。我们观察到高 BCL2/MYC 共表达与活化 B 细胞样和 MYD88L265P/CD79B 突变型 DLBCL 亚型之间存在显著关联。因此,高 BCL2/MYC 共表达鉴定出一个非 GCB DLBCL 亚组,可能对伊布替尼更敏感,值得进一步研究。该试验在 www.clinicaltrials.gov 上注册,编号为 #NCT01855750。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f99d/10188634/178f6afd22d1/BLOODA_ADV-2022-009389-gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f99d/10188634/b1b0cf5820cb/BLOODA_ADV-2022-009389-fx1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f99d/10188634/0bcda385e74a/BLOODA_ADV-2022-009389-gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f99d/10188634/5e1125383840/BLOODA_ADV-2022-009389-gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f99d/10188634/178f6afd22d1/BLOODA_ADV-2022-009389-gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f99d/10188634/b1b0cf5820cb/BLOODA_ADV-2022-009389-fx1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f99d/10188634/0bcda385e74a/BLOODA_ADV-2022-009389-gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f99d/10188634/5e1125383840/BLOODA_ADV-2022-009389-gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f99d/10188634/178f6afd22d1/BLOODA_ADV-2022-009389-gr3.jpg

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