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Ibrutinib improves survival compared with chemotherapy in mantle cell lymphoma with central nervous system relapse
C. Rusconi, CY. Cheah, TA. Eyre, D. Tucker, P. Klener, E. Giné, L. Crucitti, C. Muzi, S. Iadecola, G. Infante, S. Bernard, RL. Auer, C. Pagani, M. Duglosz-Danecka, H. Mocikova, T. van Meerten, E. Cencini, A. Marin-Niebla, ME. Williams, P....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu pozorovací studie, multicentrická studie, časopisecké články
NLK
Free Medical Journals
od 1946 do Před 1 rokem
Freely Accessible Science Journals
od 1946 do Před 1 rokem
Open Access Digital Library
od 1946-01-01
Open Access Digital Library
od 1946-01-01
ROAD: Directory of Open Access Scholarly Resources
PubMed
35789260
DOI
10.1182/blood.2022015560
Knihovny.cz E-zdroje
- MeSH
- centrální nervový systém patologie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru farmakoterapie MeSH
- lymfom z plášťových buněk * patologie MeSH
- pyrazoly škodlivé účinky MeSH
- pyrimidiny MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
Central nervous system (CNS) relapse of mantle cell lymphoma (MCL) is a rare phenomenon with dismal prognosis, where no standard therapy exists. Since the covalent Bruton tyrosine kinase (BTK) inhibitor ibrutinib is effective in relapsed/refractory MCL and penetrates the blood-brain barrier (BBB), on behalf of Fondazione Italiana Linfomi and European Mantle Cell Lymphoma Network we performed a multicenter retrospective international study to investigate the outcomes of patients treated with ibrutinib or chemoimmunotherapy. In this observational study, we recruited patients with MCL with CNS involvement at relapse who received CNS-directed therapy between 2000 and 2019. The primary objective was to compare the overall survival (OS) of patients treated with ibrutinib or BBB crossing chemotherapy. A propensity score based on a multivariable binary regression model was applied to balance treatment cohorts. Eighty-eight patients were included. The median age at study entry was 65 years (range, 39-87), 76% were males, and the median time from lymphoma diagnosis to CNS relapse was 16 months (range, 1-122). Patients were treated with ibrutinib (n = 29, ibrutinib cohort), BBB crossing chemotherapy (ie, high-dose methotrexate ± cytarabine; n = 29, BBB cohort), or miscellaneous treatments (n = 30, other therapy cohort). Both median OS (16.8 vs 4.4 months; P = .007) and median progression-free survival (PFS) (13.1 vs 3.0 months; P = .009) were superior in the ibrutinib cohort compared with the BBB cohort. Multivariable Cox regression model revealed that ibrutinib therapeutic choice was the strongest independent favorable predictive factor for both OS (hazard ratio [HR], 6.8; 95% confidence interval [CI], 2.2-21.3; P < .001) and PFS (HR, 4.6; 95% CI, 1.7-12.5; P = .002), followed by CNS progression of disease (POD) >24 months from first MCL diagnosis (HR for death, 2.4; 95% CI, 1.1-5.3; P = .026; HR for death or progression, 2.3; 95% CI, 1.1-4.6; P = .023). The addition of intrathecal (IT) chemotherapy to systemic CNS-directed therapy was not associated with superior OS (P = .502) as the morphological variant (classical vs others, P = .118). Ibrutinib was associated with superior survival compared with BBB-penetrating chemotherapy in patients with CNS relapse of MCL and should be considered as a therapeutic option.
Centre for Haemato Oncology St Bartholomew's Hospital Barts Health NHS Trust London United Kingdom
Department of Clinical Oncology Maria Sklodowska Curie National Institute of Oncology Cracow Poland
Department of Clinical Sciences and Community Health University of Milan Milan Italy
Department of Haematology Royal Cornwall Hospital NHS Trust Truro United Kingdom
Department of Hematology Sir Charles Gairdner Hospital Perth Australia
Department of Medicine 3 LMU University Hospital Munich Germany
Department of Medicine Section of Hematology University of Verona Verona Italy
Division of Hematology A O Città della Salute e della Scienza di Torino Torino Italy
Division of Hematology ASST Grande Ospedale Metropolitano Niguarda Milan Italy
Division of Hematology Cardarelli Hospital Napoli Italy
Division of Hematology Fondazione IRCCS Policlinico San Matteo Pavia Italy
Divisione di Ematologia ASST Spedali Civili Brescia Italy
Haematology and Bone Marrow Transplant Unit Guglielmo da Saliceto Hospital Piacenza Italy
Hematology Department Hospital Clínic Barcelona Spain
Hematology Department Vall d'Hebron Institute of Oncology Barcelona Spain
Hematology Oncology Division University of Virginia Cancer Center Charlottesville VA
Lymphoma Unit Department of OncoHematology San Raffaele Scientific Institute Milan Italy
Onco Hematology Unit Istituto Oncologico Veneto IOV IRCSS Castelfranco Veneto Italy
SCDU Medicina Interna a Indirizzo Ematologico AOU San Luigi Gonzaga Orbassano Italy
U O C Ematologia Ospedale Policlinico Santa Maria alle Scotte Siena Italy
University Medical Center Groningen University of Groningen Groningen The Netherlands
Citace poskytuje Crossref.org
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