在多发性骨髓瘤中,BCMA导向治疗后,临床特征与反应不佳和早期复发有关
Matthew J Rees1, Aytaj Mammadzadeh1, Abiola Bolarinwa1
1Division of Hematology, Mayo Clinic, Rochester, MN, USA.
Blood cancer journal
|July 23, 2024
概括
选择最好的BCMA导向治疗 (BDT) 对于骨髓瘤患者至关重要. 与抗体药物结合物 (ADC) 相比,化学抗原受体T细胞 (CAR-T) 治疗和T细胞参与剂 (TCE) 显示出更高的无进展生存率.
科学领域:
- 在瘤学瘤学.
- 血液学 血液学 血液学
- 免疫治疗是一种免疫疗法.
背景情况:
- 存在三类BCMA导向疗法 (BDT):抗体药物结合物 (ADC),CAR-T和T细胞参与剂 (TCE).
- 每个BDT类都有不同的优缺点,需要为临床选择提供指导.
- 患者的特征和先前的治疗史会影响BDT的结果.
研究的目的:
- 为了比较不同BCMA导向疗法 (BDT) 在多发性骨髓瘤的疗效和安全性.
- 帮助临床医生根据患者个人资料和治疗史选择最佳的BDT.
- 分析之前BDT暴露对后续治疗结果的影响.
主要方法:
- 在梅奥诊所 (2018-2023) 用商业或试验BDT治疗的339名多发性骨髓瘤患者的回顾性审查.
- 对385个BDTs进行分析,包括ADCs (n=59),TCEs (n=134) 和CAR-T (n=192).
- 使用调整的危险比率 (aHR),控制关键临床因素来比较无进展生存 (PFS) 和整体生存 (OS).
主要成果:
- 与ADC相比,CAR-T和TCE的PFS和OS明显更好,即使经过对年龄,外骨髓性疾病和先前治疗进行调整.
- 之前的BDT暴露对所有BDT类的结果产生了负面影响,特别是在CAR-T治疗中.
- 外骨髓性疾病是一种常见的复发模式 (54%),其中四分之一的病例缺乏先前的EMD病史.
结论:
- 卡特-T疗法显示出卓越的疗效,并且在可行的情况下应考虑初始BDT.
- 对于以前接触过BDT或疾病进展迅速的患者,可能需要采用替代治疗策略.
- 了解复发模式,特别是外骨髓性疾病,对于优化BDT选择和管理至关重要.
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