Sunnybrook Health Sciences Centre, Toronto, Canada.
Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Eur J Haematol. 2023 Aug;111(2):191-200. doi: 10.1111/ejh.13982. Epub 2023 May 8.
Patients with relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL) have limited treatment options.
R/R DLBCL patients, who were mostly ineligible for ASCT due to age or comorbidities, were treated with maveropepimut-S (MVP-S, previously DPX-Survivac) a survivin directed T cell educating therapy, pembrolizumab, and intermittent low-dose cyclophosphamide.
We identified, using univariate analysis, a subset of patients with enhanced ORR, PFS and DOR. Patients with baseline CD20+/PD-L1 expression had an ORR of 46% (6/13) and the disease control rate was 10/13 (77%). The PFS and OS of the positive CD20+/PD-L1 patients were 7.1 months and 17.4 months, whereas in the intent-to-treat (ITT) population of 25 enrolled patients, the ORR was 28% (7/25), median PFS and OS were 4.2 months and 10.1 months respectively. A total of 6/7 clinical responders occurred in CD20+/PD-L1 patients. The regimen was well-tolerated, requiring only minor dose modifications and one discontinuation. Grade 1 or 2 injection site reactions occurred in 14/25, (56%). Statistically significant associations were also seen between PFS and; injection site reactions; and ELISpot response to survivin peptides, both identifying the mechanistic importance of specific immune responses to survivin.
This immunotherapy combination was found to be active and safe in this clinically challenging patient population.
复发/难治性弥漫性大 B 细胞淋巴瘤（R/R DLBCL）患者的治疗选择有限。
由于年龄或合并症等原因，大多数 R/R DLBCL 患者不符合 ASCT 条件，他们接受了 Maveropepimut-S（MVP-S，以前称为 DPX-Survivac）、派姆单抗和间歇性低剂量环磷酰胺治疗。
我们通过单因素分析确定了一组具有增强缓解率（ORR）、无进展生存期（PFS）和疾病缓解持续时间（DOR）的患者。基线时 CD20+/PD-L1 表达的患者 ORR 为 46%（6/13），疾病控制率为 10/13（77%）。阳性 CD20+/PD-L1 患者的 PFS 和 OS 分别为 7.1 个月和 17.4 个月，而在纳入的 25 例意向治疗（ITT）患者中，ORR 为 28%（7/25），中位 PFS 和 OS 分别为 4.2 个月和 10.1 个月。在 7 例临床缓解者中，有 6 例发生在 CD20+/PD-L1 患者中。该方案耐受性良好，仅需要轻微剂量调整和一次停药。25 例患者中有 14 例（56%）发生 1 级或 2 级注射部位反应。PFS 与注射部位反应以及对 survivin 肽的 ELISpot 反应之间也存在显著关联，这两种反应都表明了针对 survivin 的特异性免疫反应的重要性。
该免疫治疗联合方案在这一具有挑战性的临床患者群体中具有疗效和安全性。
