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Survival Outcomes of Younger Patients With Mantle Cell Lymphoma Treated in the Rituximab Era.

ABSTRACT: PURPOSE:Mantle cell lymphoma (MCL) is a B-cell lymphoma characterized by cyclin D1 expression. Autologous hematopoietic cell transplantation (AHCT) consolidation after induction chemotherapy is often used for eligible patients; however, the benefit remains uncertain in the rituximab era. Herein we retrospectively assessed the impact of AHCT consolidation on survival in a large cohort of transplantation-eligible patients age 65 years or younger. PATIENTS AND METHODS:We retrospectively studied transplantation-eligible adults age 65 years or younger with newly diagnosed MCL treated between 2000 and 2015. The primary objective was to assess for improved progression-free survival (PFS) with AHCT consolidation and secondarily to assess for improved overall survival (OS). Cox multivariable regression analysis and propensity score-weighted (PSW) analysis were performed. RESULTS:Data were collected from 25 medical centers for 1,254 patients; 1,029 met inclusion criteria. Median follow-up for the cohort was 76 months. Median PFS and OS were 62 and 139 months, respectively. On unadjusted analysis, AHCT was associated with improved PFS (75 v 44 months with v without AHCT, respectively; P < .01) and OS (147 v 115 months with v without AHCT, respectively; P < .05). On multivariable regression analysis, AHCT was associated with improved PFS (hazard ratio [HR], 0.54; 95% CI, 0.44 to 0.66; P < .01) and a trend toward improved OS (HR, 0.77; 95% CI, 0.59 to 1.01; P = .06). After PSW analysis, AHCT remained associated with improved PFS (HR, 0.70; 95% CI, 0.59 to 0.84; P < .05) but not improved OS (HR, 0.87; 95% CI, 0.69 to 1.1; P = .2). CONCLUSION:In this large cohort of younger, transplantation-eligible patients with MCL, AHCT consolidation after induction was associated with significantly improved PFS but not OS after PSW analysis. Within the limitations of a retrospective analysis, our findings suggest that in younger, fit patients, AHCT consolidation may improve PFS.

SUBMITTER: Gerson JN

PROVIDER: S-EPMC7554677 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Survival Outcomes of Younger Patients With Mantle Cell Lymphoma Treated in the Rituximab Era.

Gerson James N JN Handorf Elizabeth E Villa Diego D Gerrie Alina S AS Chapani Parv P Li Shaoying S Medeiros L Jeffrey LJ Wang Michael I MI Cohen Jonathon B JB Calzada Oscar O Churnetski Michael C MC Hill Brian T BT Sawalha Yazeed Y Hernandez-Ilizaliturri Francisco J FJ Kothari Shalin S Vose Julie M JM Bast Martin A MA Fenske Timothy S TS Narayana Rao Gari Swapna S Maddocks Kami J KJ Bond David D Bachanova Veronika V Kolla Bhaskar B Chavez Julio J Shah Bijal B Lansigan Frederick F Burns Timothy F TF Donovan Alexandra M AM Wagner-Johnston Nina N Messmer Marcus M Mehta Amitkumar A Anderson Jennifer K JK Reddy Nishitha N Kovach Alexandra E AE Landsburg Daniel J DJ Glenn Martha M Inwards David J DJ Karmali Reem R Kaplan Jason B JB Caimi Paolo F PF Rajguru Saurabh S Evens Andrew A Klein Andreas A Umyarova Elvira E Pulluri Bhargavi B Amengual Jennifer E JE Lue Jennifer K JK Diefenbach Catherine C Fisher Richard I RI Barta Stefan K SK

Journal of clinical oncology : official journal of the American Society of Clinical Oncology 20190107 6

<h4>Purpose</h4>Mantle cell lymphoma (MCL) is a B-cell lymphoma characterized by cyclin D1 expression. Autologous hematopoietic cell transplantation (AHCT) consolidation after induction chemotherapy is often used for eligible patients; however, the benefit remains uncertain in the rituximab era. Herein we retrospectively assessed the impact of AHCT consolidation on survival in a large cohort of transplantation-eligible patients age 65 years or younger.<h4>Patients and methods</h4>We retrospectiv ...[more]

PMID: 30615550

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Project description:BackgroundMantle-cell lymphoma is generally incurable. Initial treatment is not standardized but usually includes cytotoxic chemotherapy. Lenalidomide, an immunomodulatory compound, and rituximab, an anti-CD20 antibody, are active in patients with recurrent mantle-cell lymphoma. We evaluated lenalidomide plus rituximab as a first-line therapy.MethodsWe conducted a single-group, multicenter, phase 2 study with induction and maintenance phases. During the induction phase, lenalidomide was administered at a dose of 20 mg daily on days 1 through 21 of every 28-day cycle for 12 cycles; the dose was escalated to 25 mg daily after the first cycle if no dose-limiting adverse events occurred during the first cycle and was reduced to 15 mg daily during the maintenance phase. Rituximab was administered once weekly for the first 4 weeks and then once every other cycle until disease progression. The primary end point was the overall response rate. Secondary end points included outcomes related to safety, survival, and quality of life.ResultsA total of 38 participants were enrolled at four centers from July 2011 through April 2014. The median age was 65 years. On the basis of the Mantle Cell Lymphoma International Prognostic Index scores, the proportions of participants with low-risk, intermediate-risk, and high-risk disease at baseline were similar (34%, 34%, and 32%, respectively). The most common grade 3 or 4 adverse events were neutropenia (in 50% of the patients), rash (in 29%), thrombocytopenia (in 13%), an inflammatory syndrome ("tumor flare") (in 11%), anemia (in 11%), serum sickness (in 8%), and fatigue (in 8%). At the median follow-up of 30 months (through February 2015), the overall response rate among the participants who could be evaluated was 92% (95% confidence interval [CI], 78 to 98), and the complete response rate was 64% (95% CI, 46 to 79); median progression-free survival had not been reached. The 2-year progression-free survival was estimated to be 85% (95% CI, 67 to 94), and the 2-year overall survival 97% (95% CI, 79 to 99). A response to treatment was associated with improvement in quality of life.ConclusionsCombination biologic therapy consisting of lenalidomide plus rituximab was active as initial therapy for mantle-cell lymphoma. (Funded by Celgene and Weill Cornell Medical College; ClinicalTrials.gov number, NCT01472562.).

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Survival Outcomes of Younger Patients With Mantle Cell Lymphoma Treated in the Rituximab Era.

Publications

Survival Outcomes of Younger Patients With Mantle Cell Lymphoma Treated in the Rituximab Era.

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