Younger patients with mantle cell lymphoma (MCL) who receive an autologous hematopoietic cell transplant after an induction regimen are more likely to prolong their survival with maintenance therapy.
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Maintenance with rituximab has shown in previous trials to prolong overall survival (OS) in older patients with MCL after induction therapy with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone. However, rituximab’s impact on OS in younger patients with MCL following an autologous hematopoietic cell transplant has yet to be evaluated.
Steven Le Gouill, MD, PhD, director of lymphoma research program, University of Nantes (France), and colleagues evaluated rituximab in the maintenance setting for younger patients with MCL. A total of 240 patients with previously untreated MCL aged 65 years or younger were randomly assigned to receive either rituximab maintenance (375 mg/m2) every 2 months for 3 years or no rituximab maintenance after completing induction therapy and undergoing autologous stem cell transplant.
Induction regimens included either rituximab plus dexamethasone, high-dose cytarabine, and cisplatin or rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone.
After a 50-month median follow-up, patients in the rituximab maintenance cohort had better progression-free survival than those in the non-maintenance cohort (82.2% vs 65.4%, respectively) as well as better OS (88.7% vs 81.4%, respectively). Risk of disease progression was reduced by 60% and risk of death was reduced by 50% for patients in the rituximab maintenance cohort.
Additionally, event-free survival at 4 years was greater in the rituximab maintenance cohort (78.9% vs 61.4%, respectively), also generating a 50% risk reduction. Results of the study were presented at the 58th American Society of Hematology Annual Meeting (December 3, 2016; San Diego, CA).
Researchers concluded that rituximab maintenance therapy prolonged OS in younger patients with MCL after autologous stem cell transplant. Nonetheless, they still contend that the optimal choice of induction regimen in this population remains undefined and will require further investigation. – Zachary Bessette
