妈妈的生日，瑞金中期petct评估结果5分……

yamazhaki2

今天是妈妈60岁生日，三疗中期评估Deauville评分5分，双打击、高侵袭、伴有tp53基因突变，医生建议再继续三个r-epoch96小时方案，以后每个疗程前腹部增强ct评估，期待未来三个疗程会有奇迹发生，女儿永远在您身边守护着您，不离不弃，

















保佑妈妈永远健康平安快乐

橙色雨丝

Phase I Trial of Venetoclax Plus R‐EPOCH in Aggressive B‐Cell Lymphoma
In a phase I trial, investigators examined the feasibility of combining venetoclax with dose‐adjusted EPOCH plus rituximab (DA‐EPOCH‐R) in patients with previously untreated aggressive B‐cell lymphomas. Sarah C. Rutherford, M.D., of Weill Cornell Medicine, presented the study results.
The phase I dose‐escalation trial enrolled 30 patients with newly diagnosed double‐hit lymphoma (n  = 15), DLBCL (n  = 9), transformed indolent NHL (n  = 3), primary mediastinal B‐cell lymphoma (n  = 2), and high grade B‐cell lymphoma not otherwise specified (n  = 2). The primary study objectives were to identify the maximum tolerated dose (MTD) of venetoclax with DA‐EPOCH‐R and to determine the optimal dose for phase II trials.
The first cohort of patients (n  = 18) received venetoclax according to different dosing levels (DLs), in addition to 6 cycles of DA‐EPOCH‐R:
DL1 (n  = 3): venetoclax 400 mg daily for 10 days
DL2 (n  = 9): venetoclax 600 mg daily for 10 days
DL3 (n  = 6): venetoclax 800 mg daily for 10 days

One patient experienced a dose‐limiting toxicity (grade 4 thrombocytopenia) at DL3, thereby defining the MTD. The next cohort of patients received a modified dosing schedule:
DL2B (n  = 12): venetoclax 600 mg daily for 5 days

No patients in the DL2B cohort experienced dose‐limiting toxicities. This confirmed the DL2B dosing schedule as the optimal treatment schedule for venetoclax plus DA‐EPOCH‐R in future trials. Additional adverse events (AEs) in the overall study population included febrile neutropenia in 19 patients (63%) and serious gastrointestinal AEs in 8 patients (27%). One patient discontinued treatment due to serious gastrointestinal AEs.
The combination of venetoclax plus DA‐EPOCH‐R showed promising efficacy, with an overall response rate of 97% and complete response (CR) rate of 90%. After a median follow‐up of 13.5 months, 24 of 27 responding patients remained in CR.
Building on these results, the randomized phase II/III ALLIANCE 051701 will evaluate the addition of venetoclax to DA‐EPOCH‐R or R‐CHOP in patients with MYC/BCL2 double‐hit or double‐expressor lymphoma, respectively.

这是2020年ASCO年会上报告的一项I期研究的结果，30例侵袭性B细胞淋巴瘤患者，其中一半是双重打击，用维奈托克联合DA-EPOCH-R方案，总有效率达到97%，完全缓解率达到90%，现在已经开始进行II/III期临床试验了。虽然证据不充分，但是对于双重打击并且对化疗应答不理想的患者，加上维奈托克大概是目前已知的希望最大的手段。后面可能需要做CAR-T，但是CAR-T成功的前提条件是疾病至少能保持稳定，如果持续进展，要么等不到CAR-T要么CAR-T的效果也不理想。

城北以北

加油

猫咪头欢儿

祝福，前面也是96吗？

yamazhaki2

猫咪头欢儿 发表于 2020-7-21 11:56
祝福，前面也是96吗？

对的

yamazhaki2

B细胞086--战斗 发表于 2020-7-21 13:58
个人不推荐继续化疗三次碰运气;
可考虑换二线方案试1-2疗程后转入CAR-T治疗的思路上来
...

谢谢战斗老师的建议，我再问问赵主任

橙色雨丝

中期评估PD，这是更换化疗方案和策略的明确指征。如果一定要继续用原方案，尽可能联合维奈托克或其它靶向药，否则奇迹很难发生。

yamazhaki2

橙色雨丝 发表于 2020-7-21 15:46
Phase I Trial of Venetoclax Plus R‐EPOCH in Aggressive B‐Cell Lymphoma
In a phase I trial, invest ...

非常感激雨丝老师的宝贵建议，您和战斗老师是我妈妈生命中的贵人，我来跟主治医生说

喜哥6232

直接去国外CAR-T资料吧。费用也不算高

王然然呀

加油，特别明白为人子女的心情。

carehome

要不换方案试一个疗程，千万别再继续原方案化疗了，趁早cart吧，p53阳性对cart影响不大

当厄运来敲门z

如果前期也是epoch方案，不建议还使用原方案，应该换二线方案，如果还不见效，建议cart。