The role of pembrolizumab in relapsed/refractory primary mediastinal large B-cell lymphoma

被引:25
作者
Tomassetti, Sarah [1 ]
Chen, Robert [1 ]
Dandapani, Savita [1 ]
机构
[1] City Hope Natl Med Ctr, 1500 E Duarte Rd, Duarte, CA 91010 USA
关键词
pembrolizumab; primary mediastinal B-cell lymphoma; CLASSICAL HODGKIN LYMPHOMA; BRENTUXIMAB VEDOTIN; SALVAGE CHEMOTHERAPY; PHASE-II; EXPRESSION; PD-1; TUMOR; NIVOLUMAB; SCLEROSIS; SAFETY;
D O I
10.1177/2040620719841591
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Primary mediastinal large B-cell lymphoma (PMBCL) is a subtype of diffuse large B-cell lymphoma (DLBCL). PMBCL comprises approximately 10% of DLBCLs, thus making it a rare variant of DLBCL. Cure rates for PMBCL with upfront regimens like DA-REPOCH exceed 90%. However, if there is a poor response to this first-line therapy, relapsed/refractory PMBCL (rrPMBCL) has limited treatment options. The historic trend is to treat rrPMBCL with salvage regimens commonly used for DLBCL followed by high-dose therapy and autologous stem cell transplant (HDT-ASCT); however, response rates to salvage therapy remain low and few patients are able to proceed to transplant. An interesting feature of PMBCL is that even though it is classified as a subtype of DLBCL, PMBCL actually shares many clinical, pathologic, and genetic features with classical Hodgkin lymphoma (cHL). For example, both frequently express program death ligand 1 and 2 (PD-L1/2), which is not seen in other mature B-cell lymphomas. The expression of PD-L1/2 in PMBCL makes PDL1 inhibitors, such as pembrolizumab, an attractive therapeutic target. Pembrolizumab is an effective and well-tolerated therapy now approved for a number of cancer types from advanced melanoma to relapsed/refractory cHL. There are now multi-institutional trials underway assessing the role of pembrolizumab in the treatment of rrPMBCL.
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