{"id":16039,"date":"2022-03-28T20:11:40","date_gmt":"2022-03-28T18:11:40","guid":{"rendered":"https:\/\/convergences.online\/hemato\/?p=16039"},"modified":"2024-12-11T22:06:27","modified_gmt":"2024-12-11T21:06:27","slug":"car-t-vs-autogreffe-dans-le-lymphome-en-2eme-ligne","status":"publish","type":"post","link":"https:\/\/www.hematostat.net\/en\/car-t-vs-autogreffe-dans-le-lymphome-en-2eme-ligne\/","title":{"rendered":"CAR T vs autogreffe dans le lymphome en 2e ligne"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1302px;margin-left: calc(-5% \/ 2 );margin-right: calc(-5% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:2.375%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:2.375%;--awb-width-medium:100%;--awb-spacing-right-medium:2.375%;--awb-spacing-left-medium:2.375%;--awb-width-small:100%;--awb-spacing-right-small:2.375%;--awb-spacing-left-small:2.375%;\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-1\"><p>R\u00e9f. :HematoStat.net ; 3 (1) : R48<\/p>\n<div><i><span lang=\"EN-US\">Locke FL, Miklos DB, Jacobson CA, Perales M-A, Kersten M-J, Oluwole OO, et al. Axicabtagene Ciloleucel as Second-Line Therapy for Large B-Cell Lymphoma. <\/span><span lang=\"EN-GB\">N Engl J Med. 17 f\u00e9vr 2022;386(7):640\u201154.<\/span><\/i><\/div>\n<div><\/div>\n<h3>R\u00e9sum\u00e9<\/h3>\n<div><\/div>\n<div>Dans l\u2019essai ZUMA-7, 359 patients atteints de lymphome B diffus \u00e0 grandes cellules (LBDGC) r\u00e9fractaire ou en rechute pr\u00e9coce (\u2264 12 mois) ont \u00e9t\u00e9 inclus. Les patients \u00e9taient randomis\u00e9s pour recevoir soit l\u2019axicabtagene ciloleucel (axi-cel, CAR T anti-CD19), soit une chimioth\u00e9rapie de rattrapage avec intensification et autogreffe. La dur\u00e9e de survie sans maladie \u00e9tait de 8,3 avec axi-cel contre 2 mois pour le bras de r\u00e9f\u00e9rence (suivi m\u00e9dian de 24,9 mois).<\/div>\n<div><\/div>\n<h3>Dans nos pratiques<\/h3>\n<div><\/div>\n<div>Une 2<span style=\"vertical-align: super;\">e <\/span>\u00e9tude positive (apr\u00e8s l\u2019\u00e9tude TRANSFORM) qui vient alimenter le d\u00e9bat quant \u00e0 la meilleure strat\u00e9gie \u00e0 adopter en 2<sup>e <\/sup>ligne, pour les patients r\u00e9fractaires ou en rechute pr\u00e9coce apr\u00e8s un traitement de chimioth\u00e9rapie standard. Ces r\u00e9sultats contrastent toutefois avec ceux de l\u2019essai BELINDA (tisagenlecleucel en 2<span style=\"vertical-align: super;\">e <\/span>ligne \u00e9galement), dans laquelle les CAR T faisaient jeu \u00e9gal avec la chimioth\u00e9rapie !<\/div>\n<div><\/div>\n<h3>Critique m\u00e9thodologique<\/h3>\n<div>Cet essai de phase 3 tr\u00e8s bien men\u00e9 a ceci de robuste d\u2019avoir fait appel \u00e0 un comit\u00e9 ind\u00e9pendant pour \u00e9valuer en aveugle la progression chez les patients. Les diff\u00e9rentes analyses de survie montrent bien la sup\u00e9riorit\u00e9 du traitement axi-cel par rapport au <i>standard of care<\/i>, sauf sur la survie globale qui ne montre qu\u2019un l\u00e9ger mieux (p=0.052) mais les auteurs expliquent que hors-protocole plus de la moiti\u00e9 des patients du bras contr\u00f4le ont pu b\u00e9n\u00e9ficier de la nouvelle th\u00e9rapie ce qui a pu am\u00e9liorer leur sort. Une analyse du gain du <i>switch <\/i>en termes de survie aurait \u00e9t\u00e9 un plus dans ce cas pour enfoncer le clou.<\/div>\n<\/div><\/div><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":16,"featured_media":14595,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[36],"tags":[],"ppma_author":[456],"class_list":["post-16039","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-revue-de-presse","author-alexis-genthon"],"aioseo_notices":[],"authors":[{"term_id":456,"user_id":16,"is_guest":0,"slug":"alexis-genthon","display_name":"Alexis GENTHON","avatar_url":{"url":"https:\/\/www.hematostat.net\/wp-content\/uploads\/2023\/06\/Capture-decran-2021-05-07-a-14.25.02.png","url2x":"https:\/\/www.hematostat.net\/wp-content\/uploads\/2023\/06\/Capture-decran-2021-05-07-a-14.25.02.png"},"first_name":"","last_name":"","user_url":"","description":"H\u00e9matologue.\r\nCorrespondance : H\u00f4pital Saint-Antoine \r\nService h\u00e9matologie clinique\r\n184 rue du Faubourg Saint-Antoine 75012 Paris."}],"_links":{"self":[{"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/16039","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/users\/16"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/comments?post=16039"}],"version-history":[{"count":2,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/16039\/revisions"}],"predecessor-version":[{"id":18308,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/16039\/revisions\/18308"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/"}],"wp:attachment":[{"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/media?parent=16039"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/categories?post=16039"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/tags?post=16039"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/ppma_author?post=16039"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}