ASCO 2018前瞻之四：CD5+大B的烦恼

橙色雨丝

Dose-adjusted (DA)-EPOCH-R with high-dose methotrexate (HD-MTX) for newly diagnosed stage II-IV CD5-positive diffuse large B-cell Iymphoma (CD5+ DLBCL): Primary analysis of PEARL5 study.

Background: CD5+ DLBCL comprises 5-10% of DLBCL and is characterized by various aggressive clinical features and frequent CNS relapse. Our previous retrospective study (Miyazaki et al. Ann Oncol 2011) revealed that the 2-year (yr) PFS and CNS relapse rates in patients (pts) with newly diagnosed stage II-IV CD5+ DLBCL were 51% and 15%, respectively. An interim analysis of our multicenter phase II study for newly diagnosed stage II-IV CD5+ DLBCL (PEARL5 study) revealed that DA-EPOCH-R/HD-MTX provided a high CR rate (91%) with manageable toxicity (Miyazaki et al. ASH 2016).

Methods: Pts with newly diagnosed stage II-IV CD5+ DLBCL between 20-75 yrs old and ECOG PS of 0-3 were eligible. Four cycles of DA-EPOCH-R followed by 2 cycles of HD-MTX (3.5 g/m2) and additional 4 cycles of DA-EPOCH-R were planned as the protocol treatment. Cell-of-origin of DLBCL was determined by means of NanoString analysis system. The primary endpoint was 2-yr PFS.

Results: From Aug 2012 to Nov 2015, 47 pts were enrolled in the study. AII the pts were eligible and exhibited the following features: age, 37-74 yrs (median 62); M:F = 18:29; ECOG PS > 1, 4%; stage III/IV, 53%; IPI HI/H, 47%; and ABC/GCB/unclassified, 39/4/3 (n = 46). With a median follow-up of 3.1 yrs (range, 2.0-4.9), the 2-yr PFS rate was 79% (95% CI, 64-88%). This compared favorably with the historical control of conventional R-chemotherapy (51%). The 2-yr OS rate was 89%. One pt in CR died in a traffic accident 0.8 yr after enrollment. The 2-yr CNS relapse rate was 9% (95% CI, 3-21%; n = 4). Among the 4 pts, 1 pt had primary testicular DLBCL. The remaining 3 pts experienced CNS relapse before HD-MTX. Two of these pts had high-grade B-cell lymphoma, NOS (WHO 2016) with MYC rearrangement, and the other pt discontinued the protocol treatment after the 1st rituximab due to grade 4 tumor lysis syndrome. The 2-yr PFS and OS rates in CD5+ ABC DLBCL (n = 39) were 77% and 87%, respectively.

Conclusions: DA-EPOCH-R/HD-MTX is an effective treatment for newly diagnosed stage II-IV CD5+ DLBCL. Long-term efficacy and toxicity will be evaluated in a 5-yr follow-up in Nov 2021. Clinical trial information: UMIN000008507.

给爸爸加油

如果cd5初次治疗能够达到cr
是不是可以没有愈后不好的烦恼。可以这样理解吗。

橙色雨丝

大B当中有大约5%-10%是CD5阳性的，原因不明，但是预后普遍较差，侵袭性强而且容易发生中枢神经系统侵犯。一直以来，CD5阳性大B的最佳治疗方案都不明确。日本人做的这项名为Pearl 5的临床研究显示，用DA-EPOCH-R+HD-MTX效果显著，两年PFS和OS分别为77%和87%，究竟是不是最好的方案有待长期随访来证实。

敦煌学

博学多才 大师 辛苦了

CD5+大B的烦恼   

前面不是有蛋蛋  为什么  5 5的烦恼

敦煌学

为什么不叫  5 5的烦恼

白金娃娃

您好！请问老师CD5（局灶+）是什么意思 还有CD30(散在+)

………

病理上没有写CD5就是没有的意思?还是需要深入做病理明确

c76de

记得我们最开始的诊断是滤泡3B并也有CD5+不知道是不是也属于这个范畴

敦煌学

白金娃娃 发表于 2018-5-20 16:16
您好！请问老师CD5（局灶+）是什么意思 还有CD30(散在+)

大师忙啊

（局灶+）是什么意思 还有CD30(散在+)

就是 一点点

白金娃娃

敦煌学 发表于 2018-5-21 08:52
大师忙啊

（局灶+）是什么意思 还有CD30(散在+)

非常感谢您！

敦煌学

应该的 没关系 不要客气

yinpeixi

我是CD5+，弥漫大B。

ciciIin

橙色雨丝 发表于 2018-05-20 15:36
大B当中有大约5%-10%是CD5阳性的，原因不明，但是预后普遍较差，侵袭性强而且容易发生中枢神经系统侵犯。一直以来，CD5阳性大B的最佳治疗方案都不明确。日本人做的这项名为Pearl 5的临床研究显示，用DA-EPOCH-R+HD-MTX效果显著，两年PFS和OS分别为77%和87%，究竟是不是最好的方案有待长期随访来证实。

大神，确诊弥漫大B4期，报告中显示cD5（小细胞＋），是不是就是CD5（＋）

来自安卓APP客户端

橙色雨丝

ciciIin 发表于 2022-6-17 20:09
大神，确诊弥漫大B4期，报告中显示cD5（小细胞＋），是不是就是CD5（＋）

不是