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Zhonghua Xue Ye Xue Za Zhi = Zhonghua... Jun 2023
Topics: Humans; Multiple Myeloma; Bendamustine Hydrochloride; Neoplasm Recurrence, Local; Dexamethasone; Antineoplastic Combined Chemotherapy Protocols
PubMed: 37550209
DOI: 10.3760/cma.j.issn.0253-2727.2023.06.012 -
Journal of Clinical and Experimental... Sep 2023
Topics: Humans; Lymphoma, Follicular; Bendamustine Hydrochloride; Rituximab; Antibodies, Monoclonal; Antineoplastic Combined Chemotherapy Protocols
PubMed: 37518273
DOI: 10.3960/jslrt.23015 -
Zhonghua Xue Ye Xue Za Zhi = Zhonghua... Aug 2023To evaluate the efficacy and safety of bendamustine combined with pomalidomide and dexamethasone (BPD regimen) in the treatment of relapsed multiple myeloma (MM) with...
To evaluate the efficacy and safety of bendamustine combined with pomalidomide and dexamethasone (BPD regimen) in the treatment of relapsed multiple myeloma (MM) with extramedullary disease. This open, single-arm, multicenter prospective cohort study included 30 relapsed MM patients with extramedullary disease diagnosed in seven hospitals including Qingdao Municipal Hospital. The patients were treated with BPD regimen from February 2021 to November 2022. This study analyzed the efficacy and adverse reactions of the BPD regimen. The median age of the 30 patients was 62 (47-72) years, of which 18 (60% ) had first-time recurrence. The overall response rate (ORR) of the 18 patients with first-time recurrence was 100%, of which three (16.7% ) achieved complete remission, 10 (55.5% ) achieved very good partial remission (VGPR), and five (27.8% ) achieved partial remission (PR). The ORR of 12 patients with recurrence after second-line or above treatment was 50%, including zero patients with ≥VGPR and six patients (50% ) with PR. Three cases (25% ) had stable disease, and three cases (25% ) had disease progression. The one-year progression free survival rate of all patients was 65.2% (95% 37.2% -83.1% ), and the 1-year overall survival rate was 90.0% (95% 76.2% -95.4% ). The common grade 3-4 hematology adverse reactions included two cases (6.7% ) of neutropenia and one case (3.3% ) of thrombocytopenia. The overall adverse reactions are controllable. The BPD regimen has good efficacy and tolerance in relapsed MM patients with extramedullary disease.
Topics: Humans; Middle Aged; Aged; Multiple Myeloma; Bendamustine Hydrochloride; Prospective Studies; Dexamethasone; Antineoplastic Combined Chemotherapy Protocols
PubMed: 37803841
DOI: 10.3760/cma.j.issn.0253-2727.2023.08.009 -
Frontiers in Immunology 2023The most common lymphodepletion regimen used prior to infusion of chimeric antigen receptor-T cells (CAR-T) is cyclophosphamide (CY) in combination with fludarabine... (Review)
Review
The most common lymphodepletion regimen used prior to infusion of chimeric antigen receptor-T cells (CAR-T) is cyclophosphamide (CY) in combination with fludarabine (Flu) (CY-FLU). While cyclophosphamide (CY) possesses lymphotoxic effects, it concurrently preserves regulatory T cell activity, potentially affecting the efficacy of CAR-T cells. Moreover, the use of fludarabine (FLU) has been linked to neurotoxicity, which could complicate the early detection of immune effector cell-associated neurotoxicity syndrome (ICANS) observed in CAR-T cell therapy. Given the ongoing shortage of FLU, alternative lymphodepleting agents have become necessary. To date, only a limited number of studies have directly compared different lymphodepleting regimens, and most of these comparisons have been retrospective in nature. Herein, we review the current literature on lymphodepletion preceding CAR-T cell therapies for lymphoid hematologic malignancies, with a specific focus on the use of bendamustine (BEN). Recent evidence suggests that administering BEN before CAR-T cell infusion yields comparable efficacy, possibly with a more favorable toxicity profile when compared to CY-FLU. This warrants further investigation through randomized prospective studies.
Topics: Bendamustine Hydrochloride; Receptors, Antigen, T-Cell; Receptors, Chimeric Antigen; Retrospective Studies; Prospective Studies; Cyclophosphamide
PubMed: 38077398
DOI: 10.3389/fimmu.2023.1329850 -
Indian Journal of Cancer Oct 2023Bendamustine-rituximab (BR) is the preferred regimen for the treatment of naïve follicular lymphoma (FL). Recently, lenalidomide-rituximab (LR), a chemotherapy-free... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Bendamustine-rituximab (BR) is the preferred regimen for the treatment of naïve follicular lymphoma (FL). Recently, lenalidomide-rituximab (LR), a chemotherapy-free protocol, has shown a good response rate in advanced FL. These regimens have never been compared in a randomized controlled trial for treatment-naïve FL in Indian patients.
MATERIALS AND METHODS
This Phase III open-label randomized controlled trial was conducted to compare the efficacy and safety of BR and LR. Treatment-naïve patients older than 18 years of age, ECOG PS (Eastern Cooperative Oncology Group Performance Status) ≤2, who were diagnosed with FL (Stages II-IV) were included in this study. Patients were randomized in a 1:1 ratio to receive six cycles of BR (bendamustine 90 mg/m 2 Days 1-2 and rituximab 375 mg/m 2 Day 1) every 4 weeks or LR (lenalidomide 20 mg Days 1-21 and rituximab 375 mg/m 2 ) every 4 weeks. The primary end point was complete response (CR) and secondary end points were overall response rate (ORR) and toxicity.
RESULT
We enrolled 40 patients, 20 in each group with a median age of 53 years. The CR rate was 60% and 20% in BR and LR arms, respectively ( P = 0.01); however, the ORR was 88.8% and 87.3% in BR and LR arms, respectively ( P = 1.0). Anemia (35% versus 10%), skin rash (35% versus 30%), diarrhea (30% versus 10%), vomiting (20% versus 10%), nephrotoxicity (15% versus 0%), and transaminitis (10% versus 0%) were more in LR than in BR, and thrombocytopenia was higher in the BR than in the LR group but statistically not different. All grade toxicities were seen in 90% and 45% in LR and BR, respectively ( P = 0.05), but there was no significant difference in Grade 3 or 4 toxicity between the BR and the LR regimens (20% versus 25%).
CONCLUSION
The ORR was similar in both the arms; however, the CR rate was significantly higher in the BR arm. BR was better tolerated than LR.(CTRI/2016/05/006904).
Topics: Humans; Middle Aged; Antineoplastic Combined Chemotherapy Protocols; Bendamustine Hydrochloride; Lenalidomide; Lymphoma, Follicular; Rituximab; Adult
PubMed: 38185869
DOI: 10.4103/ijc.IJC_633_20 -
Frontiers in Immunology 2023Patients with B-cell lymphoma are a fragile category of subjects, particularly exposed to infections and characterized by an impaired vaccination response due to the...
BACKGROUND
Patients with B-cell lymphoma are a fragile category of subjects, particularly exposed to infections and characterized by an impaired vaccination response due to the disease itself and, even more, to the chemotherapy regimen. For this reason, extensive knowledge of the immune response status of these subjects is of fundamental importance to obtain possible indications for a tailored immunization strategy.
METHODS
We enrolled two cohorts of patients with B-cell lymphoma under rituximab treatment or 3-24 months after treatment. In all patients, we evaluated both humoral and cellular immunological memory toward SARS-CoV-2, after standard vaccination and upon one booster dose.
RESULTS
We observed no Spike-specific IgG production in patients (n = 25) under anti-CD20 treatment, whereas patients (n = 16) vaccinated after the completion of chemotherapy showed a higher humoral response. Evaluating SARS-CoV-2-specific T-cell response, we found that patients in both cohorts had developed robust cellular immunity after vaccination. Of the 21 patients (51%) that experienced a breakthrough SARS-CoV-2 infection, only six patients developed severe disease. Interestingly, these six patients had all been treated with rituximab plus bendamustine. Notably, we observed that Spike-specific IgG levels in patients treated with rituximab plus bendamustine were absent or lower compared with those in patients treated with rituximab plus other chemotherapy, whereas Spike-specific T-cell response was not different based on chemotherapy regiment.
DISCUSSION
Our results show that, in patients with B-cell lymphoma under rituximab therapy, anti-SARS-CoV-2 mRNA vaccination induces a weak or absent humoral response but a consistent T-cell response. In addition, chemotherapy regimens with bendamustine further reduce patients' ability to mount a Spike-specific humoral response even after a long time period from chemotherapy discontinuation. These results provide evidence that different chemotherapeutics display different immunosuppressive properties that could be taken in to account in the choice of the right drug regimen for the right patient. Moreover, they question whether immunocompromised patients, particularly those treated with bendamustine, need interventions to improve vaccine-induced immune response.
Topics: Humans; Rituximab; Bendamustine Hydrochloride; COVID-19 Vaccines; SARS-CoV-2; COVID-19; Vaccination; Immunity, Cellular; Lymphoma, B-Cell; Immunoglobulin G
PubMed: 38106404
DOI: 10.3389/fimmu.2023.1322594 -
Annals of Hematology Mar 2024
Topics: Humans; Rituximab; Bendamustine Hydrochloride; Lymphohistiocytosis, Hemophagocytic; Antibodies, Monoclonal; Immunoconjugates; Antineoplastic Combined Chemotherapy Protocols; Lymphoma, Large B-Cell, Diffuse
PubMed: 38155243
DOI: 10.1007/s00277-023-05598-4 -
Journal of Clinical and Experimental... Sep 2023
Topics: Humans; Rituximab; Bendamustine Hydrochloride; Antibodies, Monoclonal; Lymphoma, Non-Hodgkin; Lymphoma, Large B-Cell, Diffuse; Antineoplastic Combined Chemotherapy Protocols
PubMed: 37518271
DOI: 10.3960/jslrt.23017 -
BMC Health Services Research Dec 2023The incidence and mortality rates of patients with chronic lymphocytic leukemia (CLL) in China have recently increased. This study performed a long-term economic...
Ibrutinib versus bendamustine plus rituximab for first-line treatment of 65 or older patients with untreated chronic lymphocytic leukemia without del(17p)/TP53 mutation in China: a lifetime economic research study.
BACKGROUND
The incidence and mortality rates of patients with chronic lymphocytic leukemia (CLL) in China have recently increased. This study performed a long-term economic evaluation of the first-line treatment strategies ibrutinib (IB) or bendamustine (BE) plus rituximab (RI) for previously untreated older patients with CLL without the del(17p)/TP53 mutation in China.
METHODS
Based on clinical data from large, randomized trials, a Markov model including four disease states (event-free survival, treatment failure, post-treatment failure, and death) was used to estimate the incremental costs per quality adjusted-life year (QALY) gained from the first-line IB strategy versus the BE plus RI strategy over a 10-year period. All costs were adjusted to 2022 values based on the Chinese Consumer Price Index, and all costs and health outcomes were discounted at an annual rate of 5%. Sensitivity analysis was performed to confirm the robustness of base-case results.
RESULTS
Compared to the first-line BE plus RI strategy, first-line IB treatment achieved 1.17 additional QALYs, but was accompanied by $88,046.78 (estimated in 2022 US dollars) in decremental costs per patient over 10 years. Thus, first-line treatment with IB appeared to have absolute dominance compared to the BE plus RI strategy. Sensitivity analysis confirmed the robustness of these results.
CONCLUSIONS
The first-line treatment with IB is absolutely cost-effective compared to the first-line BE plus RI treatment strategy for 65 or older patients with CLL without the del (17p)/TP53 mutation from the Chinese payer perspective. Therefore, it is strongly recommended that Chinese health authorities select the former strategy for these CLL patients.
Topics: Humans; Antineoplastic Combined Chemotherapy Protocols; Bendamustine Hydrochloride; Cost-Benefit Analysis; Leukemia, Lymphocytic, Chronic, B-Cell; Mutation; Rituximab; Tumor Suppressor Protein p53
PubMed: 38049834
DOI: 10.1186/s12913-023-10402-0 -
Tumori Dec 2023Multiple myeloma is a hematological cancer characterized by relapse after treatment and poor prognosis. Ixazomib, a second-generation protease inhibitor, is one of the...
Multiple myeloma is a hematological cancer characterized by relapse after treatment and poor prognosis. Ixazomib, a second-generation protease inhibitor, is one of the most recently available treatments for relapsed or refractory multiple myeloma, while it has also shown good potential as antitumoral agent in preclinical solid tumor models such as breast cancer cell lines. Here we report the case of a 68-year-old female with multiple myeloma and an incidental cT1b (9 mm) hormone receptor positive breast cancer lesion that showed a complete pathological response to a three-month combination therapy with Ixazomib, bendamustine and dexamethasone and no signs of disease relapse during the later follow-up. This is the first case report describing such clinical outcome in breast cancer following Ixazomib, bendamustine and dexamethasone combination therapy. To investigate the potential antitumoral activity of Ixazomib in breast cancer, we performed experiments using two hormone receptor positive breast cancer cell lines. We assessed the synergism between Ixazomib and bendamustine and the antiproliferative effect of Ixazomib. We found no synergistic interaction between the two drugs, while Ixazomib alone showed an antiproliferative effect against tumoral cells, suggesting that this drug has been responsible for tumor regression in our case.
Topics: Female; Humans; Aged; Multiple Myeloma; Bendamustine Hydrochloride; Breast Neoplasms; Dexamethasone; Neoplasm Recurrence, Local; Antineoplastic Combined Chemotherapy Protocols; Recurrence
PubMed: 37265183
DOI: 10.1177/03008916231176586