与利妥昔单抗联合来那度胺不同，利妥昔单抗联合布鲁顿酪氨酸激酶（BTK）抑制剂可改善双表达弥漫性大B细胞淋巴瘤的临床疗效。

RCHOP plus BTK inhibitor improves clinical outcomes in double expressor diffuse large B-cell lymphoma, unlike RCHOP plus lenalidomide.

作者信息

Feng Demei, Bai Shenrui, Liang Dong, Chen Xiaoqin, Xia Zhongjun, Liang Yang, Wang Hua

机构信息

State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.

出版信息

Leuk Res. 2025 Jan;148:107622. doi: 10.1016/j.leukres.2024.107622. Epub 2024 Nov 9.

DOI:10.1016/j.leukres.2024.107622

PMID:39549612

Abstract

BACKGROUND

Double-expressor diffuse large B-cell lymphoma (DE-DLBCL) has a poor prognosis, and optimal treatment strategies remain unclear. This study evaluates the efficacy and safety of RCHOP, R2-CHOP (RCHOP plus lenalidomide), and RCHOP plus Bruton's Tyrosine Kinase inhibitors (BTKi) in DE-DLBCL treatment.

METHODS

Data from 213 DE-DLBCL patients treated from January 2019 and February 2024. Among them, 112 received R-CHOP, 65 received R2-CHOP, and 36 received R-CHOP plus BTKi. We evaluated clinical characteristics, overall response rate (ORR), complete response (CR) rate, progression-free survival (PFS), overall survival (OS), and adverse events (AEs) for each groups.

RESULTS

Baseline characteristics were comparable across groups. ORRs were 95.5 % for R-CHOP, 96.9 % for R2-CHOP, and 97.2 % for R-CHOP plus BTKi, with CR rates of 76.5 %, 80 %, and 75 %, respectively. BTKi significantly improved PFS (p=0.033) but not affect OS (p=0.165). Lenalidomide showed no benefit in PFS (p=0.153) or OS (p=0.351). With median follow-up times of 20.6 months for R-CHOP, 23.5 months for R2-CHOP, and 17.6 months for R-CHOP plus BTKi, the 1-year PFS rates were 73.6 %, 82.2 %, and 93.3 %, and the 1-year OS rates were 96.2 %, 93.2 %, and 100 %, respectively. Grade 3-4 adverse events included leukopenia, neutropenia, and anemia, and thrombocytopenia, with no significant differences among groups.

CONCLUSION

The addition of BTK inhibitor enhances progression-free survival in DE-DLBCL, especially in advanced-stage patients, without introducing new severe adverse reactions. In contract, adding lenalidomide does not offer additional efficacy or survival benefits.

摘要

背景

双表达弥漫性大B细胞淋巴瘤（DE-DLBCL）预后较差，最佳治疗策略仍不明确。本研究评估了RCHOP、R2-CHOP（RCHOP加来那度胺）和RCHOP加布鲁顿酪氨酸激酶抑制剂（BTKi）在DE-DLBCL治疗中的疗效和安全性。

方法

收集2019年1月至2024年2月期间治疗的213例DE-DLBCL患者的数据。其中，112例接受R-CHOP治疗，65例接受R2-CHOP治疗，36例接受R-CHOP加BTKi治疗。我们评估了每组患者的临床特征、总缓解率（ORR）、完全缓解（CR）率、无进展生存期（PFS）、总生存期（OS）和不良事件（AE）。

结果

各组基线特征具有可比性。R-CHOP组的ORR为95.5%，R2-CHOP组为96.9%，R-CHOP加BTKi组为97.2%，CR率分别为76.5%、80%和75%。BTKi显著改善了PFS（p=0.033），但对OS无影响（p=0.165）。来那度胺在PFS（p=0.153）或OS（p=0.351）方面未显示出益处。R-CHOP组的中位随访时间为20.6个月，R2-CHOP组为23.5个月，R-CHOP加BTKi组为17.6个月，1年PFS率分别为73.6%、82.2%和93.3%，1年OS率分别为96.2%、93.2%和100%。3-4级不良事件包括白细胞减少、中性粒细胞减少、贫血和血小板减少，各组之间无显著差异。