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In recent years, tumor immunotherapy has developed rapidly, especially in the field of lymphoma.
The U.
S.
Food and Drug Administration (FDA) has now approved 43 drugs for the treatment of lymphoma, which is higher than other malignant tumors.
Moreover, treatment options for lymphoma are becoming more and more individualized, and it is difficult for doctors in primary hospitals to keep abreast of every update.
Based on this, the Society for Immunotherapy of Cancer (SITC) recently released the latest lymphoma immunotherapy guidelines, aiming to provide clinicians with the latest ideas on the clinical application of lymphoma immunotherapy.
Yimaitong organizes the main content as follows.
Note: The SITC lymphoma immunotherapy expert group has 12 members, including 9 medical oncologists, 1 pediatric oncologist, 1 nurse practitioner and 1 patient rights defender.
The development of this guideline follows the relevant provisions of the "American Institute of Medicine (IOM) Standards for Establishing Trusted Clinical Practice Guidelines" (hereinafter referred to as the IOM standard).
The treatment recommendations are mainly based on existing literature evidence, and clinical experience should be referred to as appropriate.
It should be emphasized that the members of the expert group only pay attention to the drugs that the FDA has approved.
Routine recommendations and clinical trials In general, the expert group recommends that all patients with lymphoma should consider participating in clinical trials.
The results of a systematic evaluation of the prognosis of patients indicate that participation in clinical trials usually does not lead to a worsening of the prognosis of patients.
Based on this finding, the expert group recommends that patients routinely participate in clinical trials, especially when approved treatment options are limited.
The expert group recommends that all newly diagnosed lymphoma patients should undergo fluorodeoxyglucose (18F-FDG) positron emission computed tomography (PET/CT) examinations, and routine complete blood counts (CBC) and serum IgG tests should be performed.
The expert group stated that for patients with reduced neutropenia and absolute lymphocyte counts detected by CBC, as well as lower serum IgG levels, relevant measures to prevent infection can be considered.
In addition, the expert group recommends that patients with newly diagnosed lymphoma should undergo cardiovascular history and risk factor assessment before receiving treatment with potential cardiotoxicity.
Based on the results of the evaluation, it is recommended that the patient receive examinations such as echocardiography and electrocardiogram, and monitor them regularly.
The treatment of patients with typical Hodgkin’s lymphoma is recommended as first-line treatment for stage I/II patients.
Regarding the first-line treatment for stage I/II classic Hodgkin’s lymphoma (cHL), the expert group recommends the ABVD regimen (doxorubicin [] Sulfate], Bleomycin, Vinblastine, Dacarbazine).
For the past 30 years, this regimen has been the standard regimen for the first-line treatment of cHL (all stages).
This recommendation is based on a prospective, randomized CALGB study of patients with newly diagnosed cHL in advanced stages.
The study was published in 1992 and compared the MOPP regimen (nitrogen mustard, vincristine, procarbazine, prednisone; it was at the time) Standard treatment plan) Curative effect of 6-8 months of treatment, 6-8 months of ABVD regimen, and 12 months of alternating treatment of MOPP regimen and ABVD regimen.
The results of the study showed that ABVD regimen for 6-8 months has the same effect as MOPP and ABVD regimen for 12 months alternate treatment, and both are better than MOPP regimen alone.
In addition, the bone marrow toxicity of the ABVD regimen is lower than the other two treatment regimens.
2 First-line treatment of stage III/IV patients Regarding the single recommended plan for the first-line treatment of stage III/IV cHL, the expert group failed to reach a consensus.
The options are ABVD and A-AVD (Vibtuximab [BV], Doxorubicin, Vinblastine, Dacarbazine).
As mentioned above, the ABVD regimen has been the standard regimen for the first-line treatment of cHL in recent years.
However, in the randomized phase III ECHELON-1 trial (NCT01712490), a median follow-up of 1334 patients with stage III/IV cHL who had not received treatment in the past 2 years showed that patients in the A-AVD regimen treatment group had progression-free survival ( PFS) rate is significantly higher.
Moreover, during the 24-month follow-up, compared with the ABVD treatment group, the A-AVD treatment group had a higher overall survival (OS) rate, but the difference was not statistically significant.
3 Second-line treatment Regarding the second-line treatment of cHL, the expert group recommends salvage chemotherapy or immunotherapy.
If the patient is eligible for transplantation, he should also receive autologous hematopoietic stem cell transplantation (ASCT).
According to the recommendations of the expert group, the options for chemotherapy or immunotherapy before ASCT include: BV+bendamustine, ICE regimen (ifosfamide, carboplatin, etoposide), BV+nivolumab and BV single agent treatment.
This recommendation is based on the AETHERA study (NCT01100502), which included BV-naïve patients who had received ASCT and had a higher risk of recurrence, and were given BV or placebo treatment.
Based on the results of this study, the FDA approved BV in 2015 as a consolidation treatment for cHL patients who have received ASCT and are at high risk of recurrence.
However, the AETHERA study only included patients who had not received BV treatment.
Whether patients who have received BV treatment can benefit from BV consolidation therapy is still under investigation.
4 The third-line treatment expert group failed to reach a consensus on a single recommended plan for the third-line treatment of cHL patients.
The third-line treatment plan includes salvage chemotherapy or immunotherapy bridging ASCT (if eligible for transplantation), PD-1 inhibitors or BV.
The choice of the plan depends on The patient’s previous treatment and the patient’s condition.
Treatment recommendations for patients with non-Hodgkin’s lymphoma 1 Diffuse large B-cell lymphoma Regarding the treatment of newly diagnosed diffuse large B-cell lymphoma (DLBCL), the expert group recommends the R-CHOP regimen (rituximab, cyclophosphamide) , Doxorubicin, vincristine and prednisone).
This recommendation is based on 3 studies of patients with previously untreated DLBCL (ECOG-4494 [NCT00003150]; GELA LNH-98.
5; MInT [NCT00064116]).
In each study, patients on the R-CHOP regimen had a prolonged PFS compared to patients treated with the CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) regimen.
In addition, for newly diagnosed children with DLBCL, members of the expert group agreed that their first-line treatment should include a combination of rituximab and FAB's main chemotherapy regimen.
Regarding the second-line treatment of DLBCL, for patients eligible for transplantation, the expert group recommends chemotherapy containing rituximab (such as rituximab + ICE, or R-ICE; rituximab + dexamethasone) + Cytarabine + Cisplatin (R-DHAP), if the patient achieves complete remission (CR) after treatment, ASCT consolidation therapy is performed.
For patients who are not eligible for transplantation, the expert group has not reached a consensus on salvage chemotherapy or immunotherapy.
Optional treatment options are lenalidomide, lenalidomide + tafasitamab-cxix, polatuzumab vedotin-piiq combined with BR (bendamustine and rituximab) regimen or appropriate salvage chemoimmunotherapy (including Li Tuximab + gemcitabine + oxaliplatin, namely R-GemOx; rituximab + gemcitabine + cisplatin + dexamethasone, namely R-GDP).
The GO29365 study (NCT02257567) provided supporting evidence for polatuzumab vedotin-piiq combined with BR regimen.
The results showed that among DLBCL patients, the median PFS and objective response rate (ORR) of the combined treatment group were significantly higher than those treated with the BR regimen.
Regarding the third-line treatment of DLBCL, the expert group recommends that fit patients choose CD19-targeted chimeric antigen receptor T (CD19 CAR-T) cell therapy axicabtagene ciloleucel (Akirensai) or tisagenlecleucel.
This recommendation is based on the single-arm ZUMA-1 (NCT02348216) trial of akirenzine for the treatment of large B-cell lymphoma, and the phase 2 JULIET study (NCT02445248) for the treatment of relapsed/refractory DLBCL with akirenzine.
For DLBCL patients who are not suitable for third-line CD19 CAR-T cell therapy, it is recommended to choose polatuzumab vedotin-piiq combined with BR regimen for treatment.
2 Mantle cell lymphoma For the first-line treatment of mantle cell lymphoma (MCL) that meets the requirements for transplantation, the expert group did not reach a unified opinion, and finally gave two options: ASCT combined with chemoimmunotherapy and chemoimmunotherapy alone.
It is worth noting that anti-CD20 monoclonal antibodies are included in the standard regimen of first-line treatment of MCL as part of the chemotherapy and immunotherapy regimen.
In addition, the expert group recommends that MCL patients undergoing ASCT receive rituximab maintenance treatment after transplantation.
For MCL patients who are not eligible for transplantation, experts recommend that their first-line treatment plan should include appropriate chemoimmunotherapy and rituximab maintenance therapy.
The expert group failed to reach a consensus on the second-line and subsequent-line treatment of MCL patients.
Alternative treatment options include brexucabtagene autoleucel, proteasome inhibitors, Bruton's tyrosine kinase (BTK) inhibitors, BTK inhibitors combined with rituximab Anti-or lenalidomide combined with rituximab.
Based on the open label Phase 2 ZUMA-2 study (NCT02601313), brexucabtagene autoleucel was approved by the FDA in July 2020.
The results of this trial show that brexucabtagene autoleucel is beneficial to improve patients' ORR, OS rate and PFS rate.
3 Follicular lymphoma.
The expert group failed to reach a consensus on the first choice for the treatment of low tumor burden follicular lymphoma (FL).
The recommended regimen is rituximab monotherapy, lenalidomide combined with rituximab, or chemotherapy.
NHL Study 4 compared the efficacy of rituximab combined with CVP regimen (cyclophosphamide, vincristine, prednisone) and CVP regimen alone.
The results showed that compared with patients in the CVP regimen alone, rituximab PFS increased significantly in patients treated with cilimab combined with CVP regimen.
In addition, in the AUGMENT study (NCT01938001), the median PFS and ORR of lenalidomide combined with rituximab in FL patients were significantly higher than those in rituximab combined with placebo.
For FL with high tumor burden, the expert group agreed that the first-line treatment should choose appropriate chemoimmunotherapy.
Regarding the second-line treatment of FL, the expert group stated that the decision should be based on comprehensive considerations such as the patient's previous treatment, tumor recurrence time, tumor volume, age, and comorbid conditions.
If the patient is eligible, the expert group recommends ibritumomab tiuxetan for the second-line treatment of FL.
This recommendation is based on the Phase 3 clinical trial of ibritumomab tiuxetan (NCT00185393).
The results of the study showed that in patients who achieved partial remission (PR) or CR after first-line treatment, the PFS of the active treatment group was treated with ibritumomab tiuxetan compared with no consolidation treatment.
Significantly increased.
When anti-CD20 monoclonal antibody treatment is needed, the expert group recommends that rituximab be preferred when conditions permit.
This recommendation is based on the GALLIUM study (NCT01332968), and its results show that it is also used for 3-year maintenance treatment in FL patients after first-line treatment.
Although obinutuzumab has advantages in PFS, the OS of the two groups of patients is not statistically significant.
Learn the difference.
In addition, for patients who have received rituximab treatment, if the patient relapses less than 6 months after the last treatment, they should switch to otuzumab; if the recurrence time exceeds 6 months, they should continue to use otuzumab Rituximab for treatment.
4 Marginal zone lymphoma For the first-line treatment of advanced, low tumor burden marginal zone lymphoma (MZL), the expert group recommends the use of rituximab for monotherapy.
For the first-line treatment of advanced, high tumor burden MZL, the expert group recommends appropriate chemotherapy and immunotherapy.
Regarding the second-line or later-line treatment of MZL, the expert group stated that it is necessary to decide which plan to use based on comprehensive considerations such as the patient's previous treatment, tumor recurrence time, tumor volume, age, and comorbid conditions.
5 Primary mediastinal B-cell lymphoma Regarding the first-line treatment of primary mediastinal B-cell lymphoma (PMLBCL, a subtype of DLBCL), the expert group recommends the DA-R-EPOCH regimen (dose-adjusted etoposide, Prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab).
This recommendation is based on a phase 2 clinical trial (NCT00001337).
The results of the study showed that patients receiving DA-R-EPOCH regimens had higher OS and event-free survival (EFS).
Another retrospective study also reached a similar conclusion.
Regarding the second-line treatment of PMLBCL, the expert group recommends a second-line treatment plan for DLBCL.
6Burkitt lymphoma Regarding the first-line treatment of Burkitt lymphoma (BL) in children, adolescents and young adults, the expert group recommends chemotherapy containing rituximab, such as rituximab + FAB main chemotherapy, or rituximab Anti+BFM (Berlin-Frankfurt-Münster) main chemotherapy.
The second-line treatment of BL in children, adolescents and young adults should choose chemotherapy containing rituximab, such as R-ICE regimen or R-CYVE regimen (rituximab, cytarabine, etoposide).
Regarding the first-line treatment of adult BL, the expert group recommends chemotherapy containing rituximab; and for the second-line treatment of adult BL, it recommends chemotherapy containing rituximab similar to its first-line treatment.
The 7T-cell lymphoma expert group failed to reach a consensus on a single recommended plan for the first-line treatment of CD30-positive peripheral T-cell lymphoma (PTCL).
The final treatment plan given was A+CHP (BV, cyclophosphamide, doxorubicin) Star, prednisone), chemotherapy alone and chemotherapy + ASCT (if the patient is eligible for transplantation). This recommendation is based in part on the ECHELON-2 study (NCT01777152), and the results show that in CD30-positive PTCL patients, compared with the CHOP regimen, the median PFS of patients receiving the first-line treatment of the A+CHP regimen was significantly improved.
Experts agree that the first-line treatment of CD30-negative PTCL should include appropriate chemotherapy and ASCT.
For a single recommended second-line treatment for PTCL patients eligible for transplantation, the expert group failed to reach a consensus.
The final treatment options given are chemotherapy + ASCT, chemotherapy + allogeneic hematopoietic stem cell transplantation (alloSCT) or histone deacetylase ( HDAC) inhibitor.
For the second-line treatment of CD30-positive PTCL patients who are not eligible for transplantation, the expert group recommends BV (a total of up to 16 doses).
This recommendation is based on a systematic review of the outcome of CD30-positive post-transplant lymphoproliferative disease (PTLD) patients who received BV treatment in clinical trials and case studies.
The results showed that more than half of the patients reached totally relaxed.
Regarding the second-line treatment of CD30-negative PTCL, the expert group recommends HDAC inhibitors.
Regarding the single recommended regimen for the first-line treatment of cutaneous T-cell lymphoma, the expert group failed to reach a consensus.
Alternatives include BV, HDAC inhibitors, and appropriate chemotherapy regimens.
Regarding the second-line treatment of skin T-cell lymphoma, the expert group has not reached a consensus.
Alternative options include HDAC inhibitors and appropriate chemotherapy regimens, such as Pratroxa and BV.
Original link: https:// stamp "Read the original", We make progress together
The U.
S.
Food and Drug Administration (FDA) has now approved 43 drugs for the treatment of lymphoma, which is higher than other malignant tumors.
Moreover, treatment options for lymphoma are becoming more and more individualized, and it is difficult for doctors in primary hospitals to keep abreast of every update.
Based on this, the Society for Immunotherapy of Cancer (SITC) recently released the latest lymphoma immunotherapy guidelines, aiming to provide clinicians with the latest ideas on the clinical application of lymphoma immunotherapy.
Yimaitong organizes the main content as follows.
Note: The SITC lymphoma immunotherapy expert group has 12 members, including 9 medical oncologists, 1 pediatric oncologist, 1 nurse practitioner and 1 patient rights defender.
The development of this guideline follows the relevant provisions of the "American Institute of Medicine (IOM) Standards for Establishing Trusted Clinical Practice Guidelines" (hereinafter referred to as the IOM standard).
The treatment recommendations are mainly based on existing literature evidence, and clinical experience should be referred to as appropriate.
It should be emphasized that the members of the expert group only pay attention to the drugs that the FDA has approved.
Routine recommendations and clinical trials In general, the expert group recommends that all patients with lymphoma should consider participating in clinical trials.
The results of a systematic evaluation of the prognosis of patients indicate that participation in clinical trials usually does not lead to a worsening of the prognosis of patients.
Based on this finding, the expert group recommends that patients routinely participate in clinical trials, especially when approved treatment options are limited.
The expert group recommends that all newly diagnosed lymphoma patients should undergo fluorodeoxyglucose (18F-FDG) positron emission computed tomography (PET/CT) examinations, and routine complete blood counts (CBC) and serum IgG tests should be performed.
The expert group stated that for patients with reduced neutropenia and absolute lymphocyte counts detected by CBC, as well as lower serum IgG levels, relevant measures to prevent infection can be considered.
In addition, the expert group recommends that patients with newly diagnosed lymphoma should undergo cardiovascular history and risk factor assessment before receiving treatment with potential cardiotoxicity.
Based on the results of the evaluation, it is recommended that the patient receive examinations such as echocardiography and electrocardiogram, and monitor them regularly.
The treatment of patients with typical Hodgkin’s lymphoma is recommended as first-line treatment for stage I/II patients.
Regarding the first-line treatment for stage I/II classic Hodgkin’s lymphoma (cHL), the expert group recommends the ABVD regimen (doxorubicin [] Sulfate], Bleomycin, Vinblastine, Dacarbazine).
For the past 30 years, this regimen has been the standard regimen for the first-line treatment of cHL (all stages).
This recommendation is based on a prospective, randomized CALGB study of patients with newly diagnosed cHL in advanced stages.
The study was published in 1992 and compared the MOPP regimen (nitrogen mustard, vincristine, procarbazine, prednisone; it was at the time) Standard treatment plan) Curative effect of 6-8 months of treatment, 6-8 months of ABVD regimen, and 12 months of alternating treatment of MOPP regimen and ABVD regimen.
The results of the study showed that ABVD regimen for 6-8 months has the same effect as MOPP and ABVD regimen for 12 months alternate treatment, and both are better than MOPP regimen alone.
In addition, the bone marrow toxicity of the ABVD regimen is lower than the other two treatment regimens.
2 First-line treatment of stage III/IV patients Regarding the single recommended plan for the first-line treatment of stage III/IV cHL, the expert group failed to reach a consensus.
The options are ABVD and A-AVD (Vibtuximab [BV], Doxorubicin, Vinblastine, Dacarbazine).
As mentioned above, the ABVD regimen has been the standard regimen for the first-line treatment of cHL in recent years.
However, in the randomized phase III ECHELON-1 trial (NCT01712490), a median follow-up of 1334 patients with stage III/IV cHL who had not received treatment in the past 2 years showed that patients in the A-AVD regimen treatment group had progression-free survival ( PFS) rate is significantly higher.
Moreover, during the 24-month follow-up, compared with the ABVD treatment group, the A-AVD treatment group had a higher overall survival (OS) rate, but the difference was not statistically significant.
3 Second-line treatment Regarding the second-line treatment of cHL, the expert group recommends salvage chemotherapy or immunotherapy.
If the patient is eligible for transplantation, he should also receive autologous hematopoietic stem cell transplantation (ASCT).
According to the recommendations of the expert group, the options for chemotherapy or immunotherapy before ASCT include: BV+bendamustine, ICE regimen (ifosfamide, carboplatin, etoposide), BV+nivolumab and BV single agent treatment.
This recommendation is based on the AETHERA study (NCT01100502), which included BV-naïve patients who had received ASCT and had a higher risk of recurrence, and were given BV or placebo treatment.
Based on the results of this study, the FDA approved BV in 2015 as a consolidation treatment for cHL patients who have received ASCT and are at high risk of recurrence.
However, the AETHERA study only included patients who had not received BV treatment.
Whether patients who have received BV treatment can benefit from BV consolidation therapy is still under investigation.
4 The third-line treatment expert group failed to reach a consensus on a single recommended plan for the third-line treatment of cHL patients.
The third-line treatment plan includes salvage chemotherapy or immunotherapy bridging ASCT (if eligible for transplantation), PD-1 inhibitors or BV.
The choice of the plan depends on The patient’s previous treatment and the patient’s condition.
Treatment recommendations for patients with non-Hodgkin’s lymphoma 1 Diffuse large B-cell lymphoma Regarding the treatment of newly diagnosed diffuse large B-cell lymphoma (DLBCL), the expert group recommends the R-CHOP regimen (rituximab, cyclophosphamide) , Doxorubicin, vincristine and prednisone).
This recommendation is based on 3 studies of patients with previously untreated DLBCL (ECOG-4494 [NCT00003150]; GELA LNH-98.
5; MInT [NCT00064116]).
In each study, patients on the R-CHOP regimen had a prolonged PFS compared to patients treated with the CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) regimen.
In addition, for newly diagnosed children with DLBCL, members of the expert group agreed that their first-line treatment should include a combination of rituximab and FAB's main chemotherapy regimen.
Regarding the second-line treatment of DLBCL, for patients eligible for transplantation, the expert group recommends chemotherapy containing rituximab (such as rituximab + ICE, or R-ICE; rituximab + dexamethasone) + Cytarabine + Cisplatin (R-DHAP), if the patient achieves complete remission (CR) after treatment, ASCT consolidation therapy is performed.
For patients who are not eligible for transplantation, the expert group has not reached a consensus on salvage chemotherapy or immunotherapy.
Optional treatment options are lenalidomide, lenalidomide + tafasitamab-cxix, polatuzumab vedotin-piiq combined with BR (bendamustine and rituximab) regimen or appropriate salvage chemoimmunotherapy (including Li Tuximab + gemcitabine + oxaliplatin, namely R-GemOx; rituximab + gemcitabine + cisplatin + dexamethasone, namely R-GDP).
The GO29365 study (NCT02257567) provided supporting evidence for polatuzumab vedotin-piiq combined with BR regimen.
The results showed that among DLBCL patients, the median PFS and objective response rate (ORR) of the combined treatment group were significantly higher than those treated with the BR regimen.
Regarding the third-line treatment of DLBCL, the expert group recommends that fit patients choose CD19-targeted chimeric antigen receptor T (CD19 CAR-T) cell therapy axicabtagene ciloleucel (Akirensai) or tisagenlecleucel.
This recommendation is based on the single-arm ZUMA-1 (NCT02348216) trial of akirenzine for the treatment of large B-cell lymphoma, and the phase 2 JULIET study (NCT02445248) for the treatment of relapsed/refractory DLBCL with akirenzine.
For DLBCL patients who are not suitable for third-line CD19 CAR-T cell therapy, it is recommended to choose polatuzumab vedotin-piiq combined with BR regimen for treatment.
2 Mantle cell lymphoma For the first-line treatment of mantle cell lymphoma (MCL) that meets the requirements for transplantation, the expert group did not reach a unified opinion, and finally gave two options: ASCT combined with chemoimmunotherapy and chemoimmunotherapy alone.
It is worth noting that anti-CD20 monoclonal antibodies are included in the standard regimen of first-line treatment of MCL as part of the chemotherapy and immunotherapy regimen.
In addition, the expert group recommends that MCL patients undergoing ASCT receive rituximab maintenance treatment after transplantation.
For MCL patients who are not eligible for transplantation, experts recommend that their first-line treatment plan should include appropriate chemoimmunotherapy and rituximab maintenance therapy.
The expert group failed to reach a consensus on the second-line and subsequent-line treatment of MCL patients.
Alternative treatment options include brexucabtagene autoleucel, proteasome inhibitors, Bruton's tyrosine kinase (BTK) inhibitors, BTK inhibitors combined with rituximab Anti-or lenalidomide combined with rituximab.
Based on the open label Phase 2 ZUMA-2 study (NCT02601313), brexucabtagene autoleucel was approved by the FDA in July 2020.
The results of this trial show that brexucabtagene autoleucel is beneficial to improve patients' ORR, OS rate and PFS rate.
3 Follicular lymphoma.
The expert group failed to reach a consensus on the first choice for the treatment of low tumor burden follicular lymphoma (FL).
The recommended regimen is rituximab monotherapy, lenalidomide combined with rituximab, or chemotherapy.
NHL Study 4 compared the efficacy of rituximab combined with CVP regimen (cyclophosphamide, vincristine, prednisone) and CVP regimen alone.
The results showed that compared with patients in the CVP regimen alone, rituximab PFS increased significantly in patients treated with cilimab combined with CVP regimen.
In addition, in the AUGMENT study (NCT01938001), the median PFS and ORR of lenalidomide combined with rituximab in FL patients were significantly higher than those in rituximab combined with placebo.
For FL with high tumor burden, the expert group agreed that the first-line treatment should choose appropriate chemoimmunotherapy.
Regarding the second-line treatment of FL, the expert group stated that the decision should be based on comprehensive considerations such as the patient's previous treatment, tumor recurrence time, tumor volume, age, and comorbid conditions.
If the patient is eligible, the expert group recommends ibritumomab tiuxetan for the second-line treatment of FL.
This recommendation is based on the Phase 3 clinical trial of ibritumomab tiuxetan (NCT00185393).
The results of the study showed that in patients who achieved partial remission (PR) or CR after first-line treatment, the PFS of the active treatment group was treated with ibritumomab tiuxetan compared with no consolidation treatment.
Significantly increased.
When anti-CD20 monoclonal antibody treatment is needed, the expert group recommends that rituximab be preferred when conditions permit.
This recommendation is based on the GALLIUM study (NCT01332968), and its results show that it is also used for 3-year maintenance treatment in FL patients after first-line treatment.
Although obinutuzumab has advantages in PFS, the OS of the two groups of patients is not statistically significant.
Learn the difference.
In addition, for patients who have received rituximab treatment, if the patient relapses less than 6 months after the last treatment, they should switch to otuzumab; if the recurrence time exceeds 6 months, they should continue to use otuzumab Rituximab for treatment.
4 Marginal zone lymphoma For the first-line treatment of advanced, low tumor burden marginal zone lymphoma (MZL), the expert group recommends the use of rituximab for monotherapy.
For the first-line treatment of advanced, high tumor burden MZL, the expert group recommends appropriate chemotherapy and immunotherapy.
Regarding the second-line or later-line treatment of MZL, the expert group stated that it is necessary to decide which plan to use based on comprehensive considerations such as the patient's previous treatment, tumor recurrence time, tumor volume, age, and comorbid conditions.
5 Primary mediastinal B-cell lymphoma Regarding the first-line treatment of primary mediastinal B-cell lymphoma (PMLBCL, a subtype of DLBCL), the expert group recommends the DA-R-EPOCH regimen (dose-adjusted etoposide, Prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab).
This recommendation is based on a phase 2 clinical trial (NCT00001337).
The results of the study showed that patients receiving DA-R-EPOCH regimens had higher OS and event-free survival (EFS).
Another retrospective study also reached a similar conclusion.
Regarding the second-line treatment of PMLBCL, the expert group recommends a second-line treatment plan for DLBCL.
6Burkitt lymphoma Regarding the first-line treatment of Burkitt lymphoma (BL) in children, adolescents and young adults, the expert group recommends chemotherapy containing rituximab, such as rituximab + FAB main chemotherapy, or rituximab Anti+BFM (Berlin-Frankfurt-Münster) main chemotherapy.
The second-line treatment of BL in children, adolescents and young adults should choose chemotherapy containing rituximab, such as R-ICE regimen or R-CYVE regimen (rituximab, cytarabine, etoposide).
Regarding the first-line treatment of adult BL, the expert group recommends chemotherapy containing rituximab; and for the second-line treatment of adult BL, it recommends chemotherapy containing rituximab similar to its first-line treatment.
The 7T-cell lymphoma expert group failed to reach a consensus on a single recommended plan for the first-line treatment of CD30-positive peripheral T-cell lymphoma (PTCL).
The final treatment plan given was A+CHP (BV, cyclophosphamide, doxorubicin) Star, prednisone), chemotherapy alone and chemotherapy + ASCT (if the patient is eligible for transplantation). This recommendation is based in part on the ECHELON-2 study (NCT01777152), and the results show that in CD30-positive PTCL patients, compared with the CHOP regimen, the median PFS of patients receiving the first-line treatment of the A+CHP regimen was significantly improved.
Experts agree that the first-line treatment of CD30-negative PTCL should include appropriate chemotherapy and ASCT.
For a single recommended second-line treatment for PTCL patients eligible for transplantation, the expert group failed to reach a consensus.
The final treatment options given are chemotherapy + ASCT, chemotherapy + allogeneic hematopoietic stem cell transplantation (alloSCT) or histone deacetylase ( HDAC) inhibitor.
For the second-line treatment of CD30-positive PTCL patients who are not eligible for transplantation, the expert group recommends BV (a total of up to 16 doses).
This recommendation is based on a systematic review of the outcome of CD30-positive post-transplant lymphoproliferative disease (PTLD) patients who received BV treatment in clinical trials and case studies.
The results showed that more than half of the patients reached totally relaxed.
Regarding the second-line treatment of CD30-negative PTCL, the expert group recommends HDAC inhibitors.
Regarding the single recommended regimen for the first-line treatment of cutaneous T-cell lymphoma, the expert group failed to reach a consensus.
Alternatives include BV, HDAC inhibitors, and appropriate chemotherapy regimens.
Regarding the second-line treatment of skin T-cell lymphoma, the expert group has not reached a consensus.
Alternative options include HDAC inhibitors and appropriate chemotherapy regimens, such as Pratroxa and BV.
Original link: https:// stamp "Read the original", We make progress together
