Dr. Daobin Zhou
Head of the Department of Hematology, Peking Union Medical College Hospital
Dr. Yan Zhang
Department of Hematology, Peking Union Medical College Hospital
Intravascular Large B-Cell Lymphoma (IVLBCL) is a subtype of large B-cell lymphoma, characterized by large tumor B-cells aggregating inside blood vessels. This disease is extremely rare and highly malignant, often involving the central nervous system, lungs, and skin. Its prognosis is poor and clinical treatment challenging. At the recently concluded 28th European Hematology Association (EHA) Annual Meeting, a study (Abstract Number: P1185) from Dr. Daobin Zhou’s team at Peking Union Medical College Hospital was selected. This study evaluated the efficacy and safety of the Zanubrutinib combined with R-CHOP regimen in treating initial IVLBCL, attracting widespread attention. To further understand this study, the Oncolgy Fronter invited Dr. Zhou for a detailed interpretation and analysis, summarized as follows:
IVLBCL is a rare type of aggressive B-cell lymphoma that does not form a tumor mass. Its diagnosis is difficult and lacks an established standard treatment. Zanubrutinib is a novel Bruton kinase inhibitor. Recent studies have shown that Zanubrutinib has good therapeutic effects in B-cell lymphomas originating from activated B-cells, those with dual expression, and those with MYD88 mutations.
To evaluate the efficacy and safety of Zanubrutinib combined with the R-CHOP regimen in primary treatment of IVLBCL, we initiated a researcher-led prospective single-arm phase II clinical trial.
As of February 14, 2023, 23 patients were included, median age 59, 14 males, all in Ann Arbor stage IV and falling under intermediate-high risk groups (IPI 3-5 points).
Efficacy data: 13 patients completed 8 cycles – 12 with complete remission and 1 with partial remission. 14 patients with baseline central nervous system involvement all achieved remission. Median follow-up was 439 days, with one patient dying of septicemia during the follow-up and no relapse reported.
Safety Data: The most common adverse reactions were hematological toxicities, such as grade 3-4 neutropenia (15/23), anemia (5/23), and thrombocytopenia (5/23). Most non-hematological toxicities occurred in the first cycle, including fatigue (13/23), infections (10/23), infusion reactions (11/23), and poor appetite (13/23).
This study showcased that the Zanubrutinib combined with R-CHOP regimen in primary IVLBCL has a significant therapeutic effect, with satisfactory safety data. The study provides reliable evidence-based medical evidence for frontline treatment of this rare subtype of lymphoma.
