Patients with chronic lymphocytic leukemia (CLL) with disease progression on ibrutinib have worse outcomes compared to patients stopping ibrutinib due to toxicity. A better understanding of expected outcomes in these patients is necessary to establish a benchmark for evaluating novel agents currently available and in development. We evaluated outcomes of 144 patients with CLL treated at Mayo Clinic with 2018 iwCLL disease progression on ibrutinib. The median overall survival (OS) for the entire cohort was 25.5 months; it was 29.8 months and 8.3 months among patients with CLL progression (n = 104) and Richter transformation (n = 38), respectively. Longer OS was observed among patients with CLL progression who had received ibrutinib in the frontline compared to relapsed/refractory setting (not reached versus 28.5 months; p = 0.04), but was similar amongst patients treated with 1, 2, or ≥3 prior lines (18.5, 30.9, and 26.0 months, respectively, p = 0.24). Among patients with CLL disease progression on ibrutinib, OS was significantly longer when next-line treatment was chimeric antigen receptor T-cell therapy (median not reached) or venetoclax-based treatment (median 29.8 months) compared to other approved treatments, such as chemoimmunotherapy, phosphoinositide 3’-kinase inhibitors, and anti-CD20 monoclonal antibodies (9.1 months; p = 0.03). These findings suggest an unmet need for this growing patient population.
与因毒性而停止依鲁替尼治疗的患者相比，慢性淋巴细胞白血病（CLL）患者在依鲁替尼治疗期间出现疾病进展的结局更差。为了更好地了解这类患者的预期结果，有必要建立一个基准，用于评估当前可用及开发中的新药。我们评估了144例在梅奥诊所接受治疗的CLL患者，这些患者均依据2018年国际慢性淋巴细胞白血病工作组（iwCLL）标准在依鲁替尼治疗期间出现疾病进展。整个队列的中位总生存期（OS）为25.5个月；其中CLL进展患者（n=104）为29.8个月，Richter转化患者（n=38）为8.3个月。在CLL进展患者中，一线使用依鲁替尼治疗的患者相较于复发/难治性患者OS更长（未达到 vs 28.5个月；p=0.04），但既往接受过1线、2线或≥3线治疗的患者OS相似（分别为18.5、30.9和26.0个月，p=0.24）。在依鲁替尼治疗后疾病进展的患者中，下一线治疗采用嵌合抗原受体T细胞疗法（中位OS未达到）或基于venetoclax的治疗（中位OS 29.8个月）时，其OS显著长于其他批准治疗，如化学免疫疗法、磷酸肌醇3-激酶抑制剂和抗CD20单克隆抗体（9.1个月；p=0.03）。这些发现表明，针对这一不断增长的患者群体，仍存在未满足的临床需求。
肿瘤(癌症)患者之家