Rituximab maintenance after autologous stem-cell transplantation in patients with mantle cell lymphoma, final result of the LyMA trial conducted on behalf the LYSA group

Abstract Introduction: First-line autologous stem cell transplantation (SCT) is an accepted therapy for mantle cell lymphoma (MCL). We have recently shown that 2 standard doses of rituximab significantly improve the outcome of TBI-based upfront SCT in MCL when administered peritransplant (Haematologica 92:42; 2007). The purpose of the present retrospective analysis was to compare this approach with alternative rituximab-based strategies. Patients and treatment strategies: 34 consecutive patients treated in KI-HH received 3–6 cycles of CHOP prior to stem cell mobilization with Dexa-BEAM (n=20) or DHAP (n=14), followed by TBI-cyclophosphamide-rituximab myeloablation and SCT (CHOP/R-TBI-CY group). Patients treated in HD received 3–8 cycles of R-CHOP for cytoreduction (n=28) and mobilization (n=23; the remaining 5 patients were mobilized with R-DHAP/HAM) followed by BEAM and SCT (R-CHOP/BEAM group). 12 patients of this group received additional rituximab maintenance after SCT. Results: With a median follow-up of 38 months (9–111), estimated 4-year progression-free survival (PFS) from diagnosis of patients treated with CHOP/R-TBI-CY and R-CHOP/BEAM was 83% and 72% (log rank, p=.38), respectively. Of note, with a median follow-up of 30 months (14–57) there was no relapse in the 12 pts receiving maintenance therapy with rituximab, translating into a significantly better 4-y PFS in patients receiving R-CHOP/BEAM with rituximab maintenance vs those without (100% vs. 56%; p=.021). The PFS difference between the R-CHOP/BEAM group and the CHOP/R-TBI-CY group became borderline significant after omitting the rituximab maintenance patients (p=.055). Conclusions: In advanced-stage MCL, addition of rituximab improves disease control provided by first-line SCT. Whereas the exact dose and timing of rituximab administration remains to be settled, prospective investigation of post-transplant rituximab maintenance appears to be particularly promising.

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Faculty Opinions recommendation of Molecular Monitoring after Autologous Stem Cell Transplantation and Preemptive Rituximab Treatment of Molecular Relapse; Results from the Nordic Mantle Cell Lymphoma Studies (MCL2 and MCL3) with Median Follow-Up of 8.5 Years.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727170548.793548360 ◽

2018 ◽

Author(s):

Leo Gordon

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

Mantle Cell Lymphoma ◽

Cell Transplantation ◽

Autologous Stem Cell Transplantation ◽

Cell Lymphoma ◽

Molecular Monitoring ◽

Mantle Cell

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The impact of socioeconomic disparities on the use of upfront autologous stem cell transplantation for mantle cell lymphoma

Leukemia & Lymphoma ◽

10.1080/10428194.2021.1978085 ◽

2021 ◽

pp. 1-9

Author(s):

Yazeed Sawalha ◽

Tomas Radivoyevitch ◽

Xuefei Jia ◽

Katherine Tullio ◽

Robert M. Dean ◽

...

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

Mantle Cell Lymphoma ◽

Cell Transplantation ◽

Autologous Stem Cell Transplantation ◽

Cell Lymphoma ◽

Socioeconomic Disparities ◽

Mantle Cell ◽

The Impact

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Current and emerging treatment options for mantle cell lymphoma

Therapeutic Advances in Hematology ◽

10.1177/2040620717719616 ◽

2017 ◽

Vol 8 (8) ◽

pp. 223-234 ◽

Cited By ~ 12

Author(s):

Bita Fakhri ◽

Brad Kahl

Keyword(s):

Stem Cell ◽

Stem Cell Transplantation ◽

Mantle Cell Lymphoma ◽

Cell Transplantation ◽

Treatment Strategy ◽

Cell Lymphoma ◽

Intensive Treatment ◽

Term Survival ◽

Rituximab Maintenance ◽

Mantle Cell

Mantle cell lymphoma (MCL) is a B-cell non-Hodgkin lymphoma with typically aggressive behavior. The genetic signature is the chromosomal translocation t(11;14)(q13;q32) resulting in overexpression of cyclin D1. Asymptomatic newly diagnosed MCL patients with low tumor burden can be closely observed, deferring therapy to the time of disease progression. Although MCL classically responds to upfront chemotherapy, it remains incurable with standard approaches. For patients in need of frontline therapy, the initial decision is whether to proceed with an intensive treatment strategy or a non-intensive treatment strategy. In general, given the unfavorable risk–benefit profile, older MCL patients should be spared intensive strategies, while younger and fit patients can be considered for intensive strategies. The bendamustine and rituximab (BR) regimen is becoming an increasingly popular treatment option among the elderly population, with improved progression-free survival (PFS) and acceptable side-effect profile. Although rituximab maintenance after R-CHOP improves survival outcomes in elderly patients, no clinical trial to date has shown statistical significance to support the use of rituximab maintenance after BR induction in older patients. In young and fit patients with MCL, an intensive strategy to maximize the length of first remission has emerged as a worldwide standard of care. With current high-dose cytarabine-containing immunochemotherapy regimens followed by autologous stem cell transplantation, the median PFS has exceeded 7 years. In the relapsed or refractory (R/R) setting, reduced intensity conditioning allogeneic hematopoietic stem cell transplantation may offer the highest likelihood of long-term survival in young R/R MCL patients, at the cost of increased risk of non-relapse mortality and chronic graft versus host disease. Novel agents targeting activated pathways in MCL cells, such as bortezomib, lenalidamide, ibrutinib and temsirolimus are now available for the management of R/R disease.

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