(Adnkronos) - “Il linfoma mantellare di solito è molto aggressivo e tende a ripresentarsi. La nuova terapia mirata, pirtobrutinib, risponde a bisogni clinici finora insoddisfatti, perché può essere utilizzata dopo un precedente inibitore di Btk, indipendentemente dalla linea di terapia". Così Maurizio Martelli, professore ordinario di Ematologia all'Azienda ospedaliero-universitaria Policlinico Umberto I di Roma, Università La Sapienza, intervenendo a Roma alla conferenza sulle novità nel trattamento del tumore del sangue.
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00:00Lymphoma Mantellare is one of the many forms of non-Hodgkin lymphoma that we have.
00:09It represents 6% of all non-Hodgkin lymphomas, with a percentage of 7-800,000 patients a year in Italy.
00:19So it is a fairly rare disease, but not infrequent.
00:23The symptoms can be very banal, the appearance of a superficial lymphadenomagalia,
00:28or the appearance of an hepatosplenomegalia.
00:32In cases of advanced disease, we can have compromises of the hemochroma.
00:37And so we can have, based on a simple hemochroma performed by routine checks,
00:42we can have a lymphocytosis or an anemia, a piastrinopenia,
00:46which can be the first sign of a compromise of the spinal cord from the point of view of lymphoma Mantellare.
00:52But here we are in a slightly more advanced form.
00:55The chemotherapy available today is differentiated into two large groups.
00:58In the so-called younger patient, I add that lymphoma Mantellare is an epidemiological disease
01:04of the adult patient, let's say older, above 65 years, but we also have very young patients.
01:10In the very young patient, in the first-line treatment, we have an immunochemotherapy,
01:15then classic chemotherapy with classic antibodies such as rituximab,
01:20followed by a transplant of peripheral stem cells of the patient himself, therefore autologous cells.
01:27Unfortunately, the disease falls back in a rather high percentage
01:31and we have a second-line treatment with inhibitors of the protein BTK,
01:36and here, fortunately, clinical research has come against it,
01:41new biological pharmacies such as Ibrutinib, which is an inhibitor of BTK.
01:47But unfortunately, here too, the answer is not long-term, there are no complete remissions
01:52and the patient can relapse a second time.
01:55Currently, in patients relapsed a second time, we have the possibility of cellular therapy with CAR-T.
02:00CAR-T, however, are programs that are not easily performed in all points,
02:05but especially not by all patients, especially the older ones,
02:09and therefore this new inhibitor, Pirtobrutinib, so-called third-generation,
02:14is not convenient and helps us treat these patients who otherwise would not have other therapeutic chances.
02:21I add that this new drug gives us the possibility of a complete and partial response
02:27over 50% with a good profile of toxicity,
02:31so I mean an oral drug, low toxicity, therefore well tolerated,
02:36well accepted also by all patients, especially the older ones.
02:40Unfortunately, the treatment, as we say, is anti-progression,
02:44until the patient manifests a progression,
02:46so it is done until the patient maintains an answer.
02:49If the patient, despite the drug, has a progression of the disease,
02:53this is the time to suspend it,
02:55but there are no studies that give a fixed treatment for a fixed duration.