Department of Hematology, Second Hospital of Shanxi Medical University, No.382 Wuyi Road, Xinghualing District, Taiyuan, Shanxi, 030000, China.
Department of Hematology, Shanxi Provincial People's Hospital, Taiyuan, 030000, China.
Ann Hematol. 2024 Nov;103(11):4649-4660. doi: 10.1007/s00277-024-05797-7. Epub 2024 May 18.
Bruton's tyrosine kinase inhibitors (BTKi) exhibit superior efficacy in relapsed/refractory primary central nervous system lymphoma (PCNSL), but few studies have evaluated patients with newly diagnosed PCNSL, and even fewer studies have evaluated differences in efficacy between treatment with BTKi and traditional chemotherapy. This study retrospectively analyzed the clinical characteristics of 86 patients with PCNSL and identified predictors of poor prognosis for overall survival (OS). After excluding patients who only received palliative care, 82 patients were evaluated for efficacy and survival. According to the induction regimen, patients were divided into the traditional chemotherapy, BTKi combination therapy, and radiotherapy groups; the objective response rates (ORR) of the three groups were 71.4%, 96.2%, and 71.4% (P = 0.037), respectively. Both median progression-free survival and median duration of remission showed statistically significant differences (P = 0.019 and P = 0.030, respectively). The median OS of the BTKi-containing therapy group was also longer than that of the traditional chemotherapy group (not reached versus 47.8 (32.5-63.1) months, P = 0.038).Seventy-one patients who achieved an ORR were further analyzed, and achieved an ORR after four cycles of treatment and maintenance therapy had prolonged OS (P = 0.003 and P = 0.043, respectively). In conclusion, survival, and prognosis of patients with newly diagnosed PCNSL are influenced by the treatment regimen, with the BTKi-containing regimen showing great potential.
布鲁顿酪氨酸激酶抑制剂 (BTKi) 在复发性/难治性原发性中枢神经系统淋巴瘤 (PCNSL) 中显示出优异的疗效,但很少有研究评估新诊断为 PCNSL 的患者,甚至更少的研究评估 BTKi 与传统化疗治疗的疗效差异。本研究回顾性分析了 86 例 PCNSL 患者的临床特征,并确定了总生存期 (OS) 预后不良的预测因素。排除仅接受姑息治疗的患者后,对 82 例患者进行了疗效和生存评估。根据诱导方案,患者分为传统化疗组、BTKi 联合治疗组和放疗组;三组的客观缓解率(ORR)分别为 71.4%、96.2%和 71.4%(P=0.037)。中位无进展生存期和中位缓解持续时间均有统计学差异(P=0.019 和 P=0.030)。BTKi 联合治疗组的中位 OS 也长于传统化疗组(未达到与 47.8(32.5-63.1)个月,P=0.038)。71 例达到 ORR 的患者进一步分析显示,治疗 4 个周期后和维持治疗后达到 ORR 的患者 OS 延长(P=0.003 和 P=0.043)。总之,新诊断的 PCNSL 患者的生存和预后受到治疗方案的影响,BTKi 联合方案具有很大的潜力。