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Lancet Haematol:MYC基因重排侵袭性B细胞淋巴瘤 可考虑剂量调整的EPOCH-R方案

2019-01-17 常路 环球医学

约10%的侵袭性B细胞淋巴瘤患者会有MYC基因重排,一半也会携带BCL2基因重排。2018年12月,发表在《Lancet Haematol.》的一项前瞻性、多中心、单组、2期研究调查了,剂量调整的EPOCH-R(依托泊苷、泼尼松、长春新碱、环磷酰胺、多柔比星、利妥昔单抗)对于既往未治疗的具有MYC基因重排的侵袭性弥漫性大B细胞淋巴瘤的结局。

约10%的侵袭性B细胞淋巴瘤患者会有MYC基因重排,一半也会携带BCL2基因重排。2018年12月,发表在《Lancet Haematol.》的一项前瞻性、多中心、单组、2期研究调查了,剂量调整的EPOCH-R(依托泊苷、泼尼松、长春新碱、环磷酰胺、多柔比星、利妥昔单抗)对于既往未治疗的具有MYC基因重排的侵袭性弥漫性大B细胞淋巴瘤的结局。

背景:多项R-CHOP(利妥昔单抗+环磷酰胺、多柔比星、长春新碱、泼尼松或泼尼松龙)的回顾性研究表明,具有MYC重排(仅MYC重排或双打击,即同时具有BCL2或BCL6重排,或同时具有BCL2和BCL6重排)比不具有MYC重排的患者的结局差,并且更强化治疗后结局改善。研究人员旨在确定一种强化输注治疗方案——剂量调整的EPOCH-R(DA-EPOCH-R)治疗未经治的具有MYC重排的侵袭性B细胞淋巴瘤的结局。

方法:研究人员进行了一项DA-EPOCH-R前瞻性、多中心、单组、2期研究的最终分析,研究对象为既往未治疗的具有MYC重排的侵袭性B细胞淋巴瘤患者。DA-EPOCH-R计划进行6个周期,与CNS预防同时进行。首要终点指标包括无事件和总生存期。

结果:纳入了53名患者,中位年龄为61岁(范围,29~80;IQR,50~70)。43名患者(81%)为III~IV期,26人(49%)具有高-中或高国际预后指数(IPI)评分。19人证实为仅MYC重排(单击),24人具有BCL2、BCL6或BCL2+BCL6重排(双击),两组患者特征相似。中位随访55.6个月(IQR,50.5~61.1)后,所有患者48个月无事件生存率为71.0%(95% CI,56.5~81.4),48个月总生存率为76.7%(95% CI,62.6~86.1)。毒性情况为,160/301个周期(53%)中具有4级中性粒细胞减少症,40个周期(13%)中具有4级血小板减少症,56个周期(19%)中具有任何级别的发烧伴中性粒细胞减少症。有3例治疗相关死亡(所有都为感染)。

结论:本研究中,DA-EPOCH-R可在具有MYC重排的侵袭性B细胞淋巴瘤患者中产生持久缓解,可考虑作为这些疾病的治疗方案。

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    2019-04-09 changfy
  2. 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    2019-04-07 okhuali
  3. 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  4. 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  5. 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href='/topic/show?id=74916e0414' target=_blank style='color:#2F92EE;'>#EMA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6704, encryptionId=74916e0414, topicName=EMA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35a460, createdName=fengyi812, createdTime=Sat Jan 19 14:45:00 CST 2019, time=2019-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1366329, encodeId=c917136632938, content=<a href='/topic/show?id=186126998e2' target=_blank style='color:#2F92EE;'>#侵袭性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26998, encryptionId=186126998e2, topicName=侵袭性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1be8234, createdName=sunyl07, createdTime=Sat Jan 19 14:45:00 CST 2019, time=2019-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1629080, encodeId=14a41629080a2, content=<a href='/topic/show?id=a2154192273' target=_blank style='color:#2F92EE;'>#基因重排#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=41922, encryptionId=a2154192273, topicName=基因重排)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=54a621283228, createdName=lqvr, createdTime=Sat Jan 19 14:45:00 CST 2019, time=2019-01-19, status=1, ipAttribution=)]
    2019-01-18 howi
  6. 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  7. 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href='/topic/show?id=74916e0414' target=_blank style='color:#2F92EE;'>#EMA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6704, encryptionId=74916e0414, topicName=EMA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35a460, createdName=fengyi812, createdTime=Sat Jan 19 14:45:00 CST 2019, time=2019-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1366329, encodeId=c917136632938, content=<a href='/topic/show?id=186126998e2' target=_blank style='color:#2F92EE;'>#侵袭性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26998, encryptionId=186126998e2, topicName=侵袭性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1be8234, createdName=sunyl07, createdTime=Sat Jan 19 14:45:00 CST 2019, time=2019-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1629080, encodeId=14a41629080a2, content=<a href='/topic/show?id=a2154192273' target=_blank style='color:#2F92EE;'>#基因重排#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=41922, encryptionId=a2154192273, topicName=基因重排)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=54a621283228, createdName=lqvr, createdTime=Sat Jan 19 14:45:00 CST 2019, time=2019-01-19, status=1, ipAttribution=)]
    2019-01-19 guihongzh
  8. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1629080, encodeId=14a41629080a2, content=<a href='/topic/show?id=a2154192273' target=_blank style='color:#2F92EE;'>#基因重排#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=41922, encryptionId=a2154192273, topicName=基因重排)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=54a621283228, createdName=lqvr, createdTime=Sat Jan 19 14:45:00 CST 2019, time=2019-01-19, status=1, ipAttribution=)]
    2019-01-19 fengyi812
  9. 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    2019-01-19 sunyl07
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    2019-01-19 lqvr

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中心点:在癌细胞中,小分子诱导的BTK降解比单纯抑制BTK具有更好的抗增殖作用。在PDX淋巴瘤模型中,先导降解剂DD-03-171可降低肿瘤负担并延长模型动物的存活期。摘要:Bruton酪氨酸激酶(BTK)供价抑制剂依鲁替尼对多种B细胞恶性肿瘤都具有很高的抗癌效果。但,依鲁替尼对BTK没有选择性,存在多重耐药机制,如C481S-BTK突变,可使其疗效大打折扣。Dennis Dobrovolsky等

邹德慧教授:Zanubrutinib在套细胞淋巴瘤(MCL)等多种B细胞淋巴瘤中应用前景广阔,成为我国自主研发药的重大里程碑

2018年12月22日,第二届百济神州血液肿瘤高峰论坛在江城武汉隆重召开。由百济神州自主研发的新型BTK抑制剂Zanubrutinib在众多血液肿瘤中的应用进展成为备受关注的热点。

ARCH PATHOL LAB MED:通过下一代测序建立克隆亲缘的解剖学和时间上不同的B细胞淋巴瘤样品的分子指纹图谱

B细胞淋巴瘤表现出平衡迁移,其涉及免疫球蛋白基因座,并且由异常的V(D)J重组,类别转换重组或体细胞超突变引起。尽管免疫球蛋白基因座中的大多数断点发生在特定的区域,但伴侣基因中的断点不同;因此,两个独立克隆不太可能在两个伴侣中具有相同的断点。因此,确定有淋巴瘤病史的患者的新病变是否代表复发或新过程可能是相关的。使用的基于聚合酶链反应(PCR)的克隆性检测仅可评估给定重排的长度。相比之下,新一代测序

NCCN临床实践指南:B细胞淋巴瘤(2019.V1)

2018年11月,美国国家综合癌症网络(NCCN)发布了B细胞淋巴瘤指南2019年第1版,指南主要内容涉及 指南更新摘要 诊断 滤泡淋巴瘤 边缘区淋巴瘤 套细胞淋巴瘤 弥漫性大B细胞淋巴瘤 伯基特淋巴瘤 AIDS相关性淋巴瘤 淋巴母细胞性淋巴瘤 移植术后淋巴组织增生性疾病 巨淋巴结增生症 使用免疫表型/基因型检测鉴别诊断成熟B-细胞和NK/T细胞肿瘤 B细胞淋巴瘤支持性护理 费霍奇金淋巴瘤卢加诺的

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