Dix ans d’expérience avec l’ibrutinib dans le lymphome des cellules du manteau
L’ibrutinib, premier inhibiteur de la tyrosine kinase de Bruton (BTK) à être admis, est désormais devenu un élément essentiel du traitement du lymphome à cellules du manteau (LCM), couramment appelé lymphome du manteau. Lors de sa présentation dans le cadre de la manifestation de formation continue Medical Tribune « Milestones in Hematology » du 2 novembre 2023, le Pr Martin Dreyling, Centre clinique, Université Louis-Maximilien, Munich, a expliqué comment l’ibrutinib s’intègre dans un traitement optimal du LCM, en l’état actuel et à l’avenir.
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D’un point de vue clinique, le LCM évolue en deux phases (1). Après une phase plutôt indolente, le LCM nodal classique et le LCM non nodal leucémique peuvent être suivis d’une phase plus agressive. En pratique, cette dernière est caractérisée par trois paramètres :
- cytomorphologie blastoïde
- mutation de p53 et
- indice Ki-67 élevé (≥30 %).
En présence d’un de ces trois facteurs de risque, la survie globale médiane (OS) n’est que d’environ 5 ans (2), alors que deux tiers des patients sont encore en vie après 10 ans en cas de LCM indolent. Améliorer le pronostic prend donc toute son importance, en particulier chez les patients à haut risque.
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- Onkopedia-Leitlinie «Mantelzell-Lymphom», Stand Juni 2023
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