BTK抑制剂治疗不同类型B细胞淋巴瘤疗效的回顾分析  

Retrospective analysis of the efficacy of BTK inhibitors in the treatment of different types of B-cell lymphoma

作　　者：曾珊 陈敏仪 殷淑文 黄红兵[1] 刘韬[1] 周捷[1] ZENG Shan;CHEN Min-yi;YIN Shu-wen(Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in South China,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy,Guangzhou 510060,China)

机构地区：[1]中山大学肿瘤防治中心,华南恶性肿瘤防治全国重点实验室,广东省鼻咽癌诊治研究重点实验室,广州510060

出　　处：《中国处方药》2024年第7期1-5,共5页Journal of China Prescription Drug

摘　　要：目的比较不同Bruton酪氨酸激酶(BTK)抑制剂对各类B细胞淋巴瘤的疗效,为优化治疗方案提供参考。方法收集B细胞淋巴瘤患者的PET/CT、肿瘤标志物检测、不良反应、用药方案等临床资料,按淋巴瘤类别和不同用药方案分组,比较使用伊布替尼、泽布替尼和奥布替尼对慢性淋巴细胞白血病/小淋巴细胞淋巴瘤(CLL/SLL)、弥漫大B细胞淋巴瘤(DLBCL)、套细胞淋巴瘤(MCL)的疗效和各种不良反应的发生率。结果治疗CLL/SLL,奥布替尼客观缓解率(ORR)为70.59%,泽布替尼ORR为64.52%,伊布替尼ORR为45.00%;对于DLBCL,纳入研究的治疗方案为BTK抑制剂联合R+CHOP方案,奥布替尼ORR为54.55%、泽布替尼ORR为47.62%、伊布替尼ORR为41.67%;对于MCL,泽布替尼ORR高达81.82%,奥布替尼ORR为71.43%,伊布替尼ORR为62.50%。3种BTK抑制剂均可降低β2微球蛋白(β2-MG)的水平,其中奥布替尼可显著降低CLL/SLL、DLBCL、MCL患者血清中β2-MG的含量(P<0.05)。在不良反应方面,使用奥布替尼治疗CLL/SLL、DLBCL、MCL患者腹泻、呼吸道感染、肌肉酸痛发生率均为最低。其中MCL患者中奥布替尼腹泻发生率最低且经比较,差异有统计学意义(P<0.05)。三种BTK抑制剂中性粒细胞减少、血小板减少和贫血的发生率在同病种组内比较,差异均无统计学意义(P>0.05)。结论奥布替尼治疗CLL/SLL疗效最高,泽布替尼治疗MCL疗效最高,3种BTK抑制剂联合R+CHOP方案治疗DLBCL疗效相近,其中奥布替尼略高。综合比较各项不良反应发生率,奥布替尼安全性最好。Objective To compare the efficacy of different BTK inhibitors on various types of B-cell lymphoma and provide reference for optimizing therapy.Methods Clinical data including PET/CT,tumor marker detection,adverse reactions and medication regimens were collected from patients with B-cell lymphoma.The patients were grouped according to the type of lymphoma and different regimens.The efficacy and incidence of ibrutinib,zanubrutinib,and orelabrutinib on chronic lymphocytic leukemia/small lymphocytic lymphoma(CLL/SLL),diffuse large B-cell lymphoma(DLBCL)and mantle cell lymphoma(MCL)were compared.Results For CLL/SLL,orelabrutinib ORR was 70.59%,zanubrutinib ORR was 64.52%,ibrutinib ORR was 45.00%.For DLBCL,the regimen in the study was BTK inhibitor combined with R+CHOP,with an ORR of 54.55%for orelabrutinib,47.62%for zanubrutinib and 41.67%for ibrutinib.For MCL,zanubrutinib ORR was 81.82%,orelabrutinib ORR was 71.43%and ibrutinib ORR was 62.50%.The three BTK inhibitors could reduceβ2-MG level,among them,orelabrutinib could significantly reduce the serum concentrationβ2-MG of CLL/SLL,DLBCL and MCL(P<0.05).In terms of the adverse reactions,diarrhea,respiratory infections and muscle soreness showed the lowest rate in patients with CLL/SLL,DLBCL,MCL who were treated with orelabrutinib,and among the MCL patients,orelabrutinib treating had the lowest diarrhea incidence,and the difference was statistically significant(P<0.05).Neutropenia,thrombocytopenia,and anemia during the treatment of three BTK inhibitors were not significantly different within the same disease group.Conclusion Orelabrutinib showed the highest therapeutic effect on CLL/SLL,zanubrutinib showed the best therapeutic effect on MCL.The efficacy of three BTK inhibitor combined with R+CHOP in the treatment of DLBCL was similar,with slightly higher levels of orelabrutinib.Comprehensive comparison of the incidence of various adverse,orelabrutinib showed the best safety.

关 键 词：B细胞淋巴瘤 伊布替尼 泽布替尼 奥布替尼 

分 类 号：R969[医药卫生—药理学]