Abstract：
To explore the optimal treatment for young patients with untreated mantle cell lymphoma (MCL), we compared the efficacy and safety of R-CHOP/R-DHAP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone/rituximab, dexamethasone, cytarabine and cisplatin) and R-BAP (rituximab, bendamustine, cytarabine, and prednisone) plus BTK (Bruton\'s tyrosine kinase) inhibitors in newly diagnosed patients. Eighty-three young patients (≤ 65 years old) with newly diagnosed MCL admitted to the First Affiliated Hospital of Zhengzhou University from January 1, 2014, to June 1, 2023, using R-CHOP/R-DHAP or R-BAP plus BTK inhibitor were assessed in this study. The median age at presentation was 60 (42-65) years in 83 patients, including 64 males and 19 females; 59 were treated with R-CHOP/R-DHAP regimen chemotherapy, and 24 were treated with R-BAP in combination with the BTK inhibitor regimen. The median follow-up was 17 months (2-86 months) in 83 patients, and the median PFS (progression-free survival) time was not reached. The CRR (complete response rate) of the R-BAP group was higher than that of the R-CHOP/R-DHAP group (87.5% vs. 54.2%, P = 0.005). The ORR (overall response rate) was not significantly different between the two groups (ORR: 91.7% vs. 84.7%, P = 0.497). The PFS (progression-free survival) of the R-BAP group was longer than that of the R-CHOP/R-DHAP group (P = 0.013), whereas OS was not significantly different between the two groups (P = 0.499). The most common adverse effect in both groups was hematotoxicity, with a higher incidence of grade 3-4 lymphopenia and grade 3-4 thrombocytopenia in the R-BAP group than in the R-CHOP/R-DHAP group (P = 0.015 and P = 0.039). Male sex (HR = 4.257, P = 0.013), LDH (lactate dehydrogenase) ≥ 245 U/L (HR = 3.221, P = 0.012), pleomorphic-blastoid (HR = 2.802, P = 0.043) and R-CHOP/R-DHAP regimen (HR = 7.704, P = 0.047) were independent risk factors for PFS. Ki67 ≥ 30% (HR = 8.539, P = 0.005) was an independent risk factor for OS. First-line treatment with R-BAP in combination with BTK inhibitor improved CRR and prolonged PFS in young patients with mantle cell lymphoma and adverse events were tolerable.
摘要：
探讨青年未经治疗的套细胞淋巴瘤(MCL)的最佳治疗方法,我们比较了R-CHOP/R-DHAP（利妥昔单抗，环磷酰胺,阿霉素,长春新碱和泼尼松/利妥昔单抗，地塞米松,阿糖胞苷和顺铂）和R-BAP（利妥昔单抗，苯达莫司汀,阿糖胞苷,和泼尼松）加BTK（布鲁顿酪氨酸激酶）抑制剂治疗新诊断患者。本研究评估了2014年1月1日至2023年6月1日郑州大学第一附属医院收治的83例新诊断的MCL青年患者（≤65岁），使用R-CHOP/R-DHAP或R-BAP联合BTK抑制剂。83例患者的中位年龄为60（42-65）岁，男64例,女19例;59例采用R-CHOP/R-DHAP方案化疗,24例接受R-BAP联合BTK抑制剂方案治疗。83例患者中位随访时间为17个月(2-86个月),未达到中位PFS(无进展生存期)时间.R-BAP组的CRR（完全缓解率）高于R-CHOP/R-DHAP组（87.5%vs.54.2%,P=0.005)。两组之间的ORR（总体反应率）没有显着差异（ORR：91.7％vs.84.7%,P=0.497)。R-BAP组的无进展生存期(PFS)长于R-CHOP/R-DHAP组(P=0.013),而OS在两组间无显著差异(P=0.499)。两组中最常见的不良反应是血液毒性，与R-CHOP/R-DHAP组相比，R-BAP组的3-4级淋巴细胞减少和3-4级血小板减少的发生率更高（P=0.015和P=0.039）。男性(HR=4.257,P=0.013),LDH(乳酸脱氢酶)≥245U/L(HR=3.221,P=0.012),多形囊样(HR=2.802,P=0.043)和R-CHOP/R-DHAP方案(HR=7.704,P=0.047)是影响PFS的独立危险因素。Ki67≥30%(HR=8.539,P=0.005)是OS的独立危险因素。R-BAP与BTK抑制剂联合一线治疗可改善年轻套细胞淋巴瘤患者的CRR和延长PFS，不良事件可耐受。
