Journal Article

Outcomes in first relapsed-refractory younger patients with mantle cell lymphoma: results from the MANTLE-FIRST study

Hohaus, Stefan, Ferrero, Simone, Chiappella, Annalisa, Nassi, Luca, Gini, Guido, Visco, Carlo, Polli, Valentina, Morello, Lucia, Di Rocco, Alice, Tecchio, Cristina, Zilioli, Vittorio Ruggero, Krampera, Mauro, Celis, Maria Isabel Alvarez De, McCulloch, Rory, Pennese, Elsa, Petrucci, Luca, Balzarotti, Monica, Evangelista, Andrea, Quaglia, Francesca Maria, Sica, Antonello, Re, Alessandro, Rusconi, Chiara, Stefani, Piero Maria, Bozzoli, Valentina, Perrone, Tommasina, Tisi, Maria Chiara, Rule, Simon, Arcaini, Luca, Cox, Maria Christina, Vitolo, Umberto, Sciarra, Roberta, Marin-Niebla, Ana, Fabbri, Alberto

2021

Overview

Patients with mantle cell lymphoma (MCL) that fail induction treatment represent a difficult-to-treat population, where no standard therapy exists. We evaluated outcomes in patients with first relapsed-refractory (r/r) MCL after upfront high dose cytarabine including standard regimens. Overall survival (OS-2) and progression-free survival (PFS-2) were estimated from the time of salvage therapy. The previously described threshold of 24 months was used to define patients as early- or late-progressors (POD). Overall, 261 r/r MCL patients were included. Second-line regimens consisted of rituximab-bendamustine (R-B, 21%), R-B and cytarabine (R-BAC, 29%), ibrutinib (19%), and others (31%). The four groups were balanced in terms of clinicopathological features. Adjusting for age and early/late-POD, patients treated with R-BAC had significantly higher complete remission (63%) than comparators. Overall, Ibrutinib and R-BAC were associated with improved median PFS-2 [24 and 25 months, respectively], compared to R-B (13) or others (7). In patients with early-POD ( n  = 127), ibrutinib was associated with inferior risk of death than comparators (HR 2.41 for R-B, 2.17 for others, 2.78 for R-BAC). In patients with late-POD ( n  = 134), no significant differences were observed between ibrutinib and bendamustine-based treatments. Ibrutinib was associated with improved outcome in early-POD patients.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 692/699/1541/1990/291/1621/1915 / 692/700/565/1436/1437 / 692/700/565/251 / Adult / Aged / Antineoplastic Combined Chemotherapy Protocols - therapeutic use / Cancer Research / Comparators / Critical Care Medicine / Cytarabine / Development and progression / Drug Resistance, Neoplasm / Drug therapy / Evaluation / Female / Follow-Up Studies / Hematology / Humans / Immunotherapy / Inhibitor drugs / Intensive / Internal Medicine / International Agencies / Lymphoma / Lymphoma, Mantle-Cell - drug therapy / Lymphoma, Mantle-Cell - mortality / Lymphoma, Mantle-Cell - pathology / Male / Mantle cell lymphoma / Medical treatment / Medicine / Medicine & Public Health / Middle Aged / Monoclonal antibodies / Neoplasm Recurrence, Local - drug therapy / Neoplasm Recurrence, Local - mortality / Neoplasm Recurrence, Local - pathology / Oncology / Prognosis / Remission / Retrospective Studies / Rituximab / Salvage Therapy / Survival / Survival Rate / Targeted cancer therapy / Young Adult