Maintenance Therapy Effective in MCL After ASCT

12/01/17

Maintenance therapy with a specific drug is associated with superior overall survival (OS) and progression-free survival (PFS) in patients who receive high-dose therapy followed by autologous stem cell transplantation (ASCT) for mantle cell lymphoma (MCL).

High-dose therapy along with ASCT has shown to improve outcomes for patients with MCL. However, this treatment strategy is often associated with an increased incidence of relapse.

Matthew G Mei, MD, department of hematology and hematopoietic cell transplantation, City of Hope National Medical Center (Duarte, CA), and colleagues conducted a retrospective, single-center study of patients with MCL who underwent high-dose therapy plus ASCT to examine prognostic factors for outcomes. A total of 191 patients were enrolled in the study, 92% (n = 175) of whom received rituximab before ASCT and 39% (n = 75) received maintenance rituximab after ASCT.

Results of the study were published in Biology of Blood and Marrow Transplantation (November 2017;23[11]:1861-1869).

Researchers found that in all patients, the 5-year OS was 71% (95% CI, 63%-77%) and the PFS was 53% (95% CI, 45%-60%). The 5-year cumulative incidence of relapse was 41% (95% CI, 34%-48%) with a continuous pattern of relapse events occurring at a median of 2.1 years after ASCT.

In a multivariate analysis, maintenance rituximab therapy after ASCT was found to be the most important factor associated with improvement in PFS (relative risk [RR], 0.25; 95% CI, 0.14-0.44) and OS (RR, 0.17; 95% CI, 0.07-0.38).

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In the subset of patients who had PET data available and were in a PET-negative first complete remission at ASCT (n = 105), maintenance rituximab therapy was significantly associated with superior OS (RR, 0.17; 95% CI, 0.05-0.59) and PFS (RR, 0.20; 95% CI, 0.09-0.43).

In their concluding remarks, Dr Mei and colleagues wrote that the benefit of maintenance rituximab therapy “stands out, and adds to the increasing body of evidence supporting this practice for all MCL patients after ASCT, regardless of age and frontline induction regimens.”

“This study also sets the stage for prospective investigation aiming at optimization of maintenance therapy following ASCT,” they added.—Zachary Bessette