Fiche publication
Date publication
mars 2025
Journal
Blood advances
Auteurs
Membres identifiés du Cancéropôle Est :
Pr FEUGIER Pierre
,
Pr FORNECKER Luc-Matthieu
,
Pr ROSSI Cédric
Tous les auteurs :
Camus V, Molina TJ, Desmots F, Blanc-Durand P, Kanoun S, Moslemi A, Ruminy P, Le Gouill S, Ghesquieres H, Obéric L, Morschhauser F, Tilly H, Ribrag V, Houot R, Thieblemont C, Maisonneuve HG, Claves F, Bouabdallah K, Haioun C, Damaj G, Fornecker LM, Noel R, Feugier P, Sibon D, Cartron G, Bonnet C, Bernard W, Kraeber-Bodere F, Bodet-Milin C, Jais JP, Briere J, Rossi C, Elsensohn MH, Chartier L, Itti E, Jardin F, Fest T
Lien Pubmed
Résumé
The GAINED study (NCT01659099) was a randomized phase 3 trial comparing obinutuzumab (G) to rituximab (R) plus ACVBP or CHOP14 induction, followed by PET-guided consolidation. This post-hoc analysis aimed to detail the outcomes of primary mediastinal B-cell lymphoma (PMBL) patients, verified through expert pathological review and the use of gene-expression profiling (GEP) and Next-Generation sequencing. Of the centrally reviewed 620 patients, 138 (22.3%) confirmed PMBL cases were analyzed. Baseline characteristics included a median age of 33.5 years, 63.8% female, 55.1% stage III-IV, 90.6% elevated LDH, 87.6% ECOG 0-1, 62.3% extranodal involvement, 52.6% aaIPI 2-3, and 53.6% Bulk (>10cm). Induction regimens were R/G-CHOP14 (56.9%) and R/G-ACVBP (43.1%). Post-induction treatments, based on interim PET (iPET) results, included: standard consolidation chemotherapy (59.8%) if ΔSUVmax >66% after cycle 2 and >70% after cycle 4 (PET2-/4-), intensive treatment and autologous transplantation (26.8%) if PET2+/4-, and salvage therapy (13.4%) if PET4+ (ΔSUVmax ≤70%). Among patients with GEP data (n=107), 38 (35.5%) were PDL1high/PDL2high. Key somatic mutations data (n=87) included SOCS1 (70.1%), B2M (56.3%), STAT6 (49.4%), TNFAIP3 (47.1%), GNA13 (39.1%), CIITA (37.9%), CD58 (36.8%), and TP53 (29.9%). After a median follow-up of 39.5 months, 2-year PFS and OS rates were 86.2% and 93.2%, respectively. In a multivariate model including Bulk, aaIPI, and ΔSUVmax PET2/PET4, only Bulk and ΔSUVmax PET4 ≤70% were associated with shorter PFS (HR 4.39 [1.28-15.11] and 4.95 [1.71-14.3], respectively), while none were associated with OS. The ΔSUVmax-based interim PET4 response emerged as the strongest predictor of patient outcomes in this selected clinical trial population.
Référence
Blood Adv. 2025 03 3;:
