2020 EHA Express-Lymphoma Microclass: Ibtinib can significantly improve the recurrent central nervous system's cell lymphoma remission and survival.

Welcome to the lymphoma micro class.I am Dr. Li Zhiming from the Department of internal medicine, cancer prevention and treatment center, Sun Yat sen University.I would like to share with you today an abstract of oral published by the 2020 EHA, which compared the efficacy of ibutilib and immunochemotherapy in the treatment of recurrent mantle cell lymphoma (MCL) in the central nervous system.first, let's take a look at the background of this study. Recurrent central nervous system (CNS) recurrence of mantle cell lymphoma (MCL) is a rare phenomenon, and there is no clear standard treatment. The median survival time was less than 6 months.currently, ibutilib has been approved for the treatment of recurrent / refractory MCL, and small sample studies have confirmed that ibutilib can penetrate the blood-brain barrier (BBB) and is effective in CNS diseases.in this study, we analyzed the prognosis of MCL patients with CNS involvement after recurrence, and compared the remission rate and survival rate between patients receiving ibutilib and those receiving standard treatment.to take a look at the methodology of this study, we retrospectively analyzed MCL patients who received systematic treatment in 38 centers from 2000 to 2019 and had recurrent CNS.overall survival (OS) was defined as the time from the beginning of cns-mcl treatment to death.What are the results? First of all, let's look at the situation of the enrolled patients: a total of 84 patients were included in the analysis: 58 cases, 69% of the patients received standard immunochemotherapy, known as the standard group (SC); 26 cases, 31% of the patients received ibuprotinib treatment, known as the ibuprotinib group (IC).the baseline characteristics of the two groups were similar - the median age of the standard group was 62 years (range: 38-84 years), and the median age of the ibutilinib group was 63 years (range: 48-77 years) (P = 0.26). In the standard group and the ibutilinib group, 29% and 24% (P = 0.78) respectively. The proportion of patients with higher Mipi score in the standard group and ibutilinib group was 63% and 71% (P = 0.64) CN, respectively The median time between the first diagnosis of MCL and CNS recurrence was 15 months in the standard group (range: 2-122) and 19 months (range: 1-86) (P = 0.45) in the standard group and 1 (range: 1-2) in the ibutilinib group (P = 0.45) These included: 28 patients (48%) received rituximab + blood-brain barrier therapy, 6 patients (11%) received rituximab + bendamustine treatment, 17 patients (29%) received intrathecal (it) chemotherapy, and 7 patients (12%) received radiotherapy.the treatment of blood-brain barrier included: 7 patients (25%) received high-dose methotrexate monotherapy, 19 patients (68%) received high-dose methotrexate combined with high-dose Ara-C, and 2 patients (7%) received ifosfamide based regimen. In the standard group, 45 patients (78%) received additional intrathecal therapy.in the ibuprotinib group, 560 mg of ibuprotinib was orally administered daily until the disease progressed or became toxic; 12 patients (46%) received intrathecal chemotherapy at the same time.next, let's look at the comparison of efficacy between the two groups: of the 84 patients enrolled, 79 (89%) received the efficacy evaluation.the overall response rate (ORR) was 72% in the ibuprotinib group, 39% in the standard group, and 42% in the ibuprotinib group and 17% in the standard group.in the standard group, the orr was 46% and the CR rate was 22%. There was a significant difference in CR rate between the ibuprotinib group and the BBB treatment group (42% vs 22%, P = 0.02).with a median follow-up of 4.3 months, the 1-year OS of the whole study population was 27%, that of the standard group was 16%, and that of the ibutilinib group was 61%, which was significantly improved compared with the standard group (61% vs 16%; HR = 0.29, P & lt; There was no significant difference between the two groups (P = 0.001) In terms of safety, no accidental toxicity was reported in the ibutilinib group, including cases of non-invasive fungal infection. Overall, this is the first large sample study to analyze the outcome of ibutilib in patients with central recurrence of MCL.despite the limitations of the retrospective analysis, the results of this study showed that compared with standard immunochemotherapy, ibutilinib improved the remission rate and survival time of this group of patients, and half of the patients could survive for more than 1 year. this is the end of this [lymphoma micro lecture]. Thank you for watching. med-onc-cn-1323 References: Chiara Rusconi, et al. Ibrutinib compared to immune chemotherapy for central nervous system relax of mantle cell lymphama: a report from Fondazione Italiana linfomi (FIL) and European mantle cell lymphama network (emcln). 2020 EHA. Abstract: s229 stamp "read the original", let's progress together