MCL

Long term follow-up results of rituximab maintenance in elderly MCL patients after first-line immunochemotherapy – ASH 2017 Oral Abstract #153

The 59th Annual Meeting & Exposition of the American Society of Hematology (ASH) took place in Atlanta, GA, on 9–12 December,2017. On Saturday December 9th, an oral abstract session was held on “Mantle Cell, Follicular, and Other Indolent B-Cell Lymphoma—Clinical Studies: Mantle Cell Lymphoma, New Therapies”. This article is based on data presented at the live session, which may supersede information in the pre-published ASH Abstract.

Abstract #153 was presented during this session, titled “Rituximab Maintenance after First-Line Immunochemotherapy in Mantle Cell Lymphoma: Long-Term Follow-up of the Randomized European MCL Elderly Trial” by Eva Hoster, Department of Medicine III, University Hospital of the Ludwig Maximilians University of Munich, Germany.

Study Highlights
  • 560 elderly patients were included in the study with a median age of 70 years (60–87)
    • Patients were randomized to receive induction therapy with either 8 cycles of R-CHOP (rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone) or 6 cycles of R-FC (rituximab with fludarabine and cyclophosphamide)
    • Patients were then randomized to receive maintenance therapy with either rituximab (R) or interferon-alpha (IFN)
  • This study aimed to assess outcomes in elderly MCL patients after long term follow-up (median follow-up = 6.7 years) 
Key Findings 
  • Comparison of R-FC vs R-CHOP induction therapy:
    • Cumulative incidence of death without treatment failure: 19% vs 9%, P = 0.0032
    • Failure-free survival (FFS) 5-year probability: 31% (95% CI, 25–37) vs 31% (95% CI, 25–37), P = 0.76
    • Overall survival (OS) 5-year probability: 42% (95% CI, 36–49) vs 58% (95% CI, 51–64), P = 0.0012
  • Comparison of R vs IFN maintenance therapy:
    • After R-CHOP 5-year PFS: 51% (95% CI, 40–62) vs 22% (95% CI, 14–32), P < 0.0001
    • After R-FC 5-year PFS: 52% (95% CI, 39–63) vs 32% (95% CI, 20–45), P = 0.032
    • After R-CHOP 5-year OS: 79% (95% CI, 67–86) vs 59% (95% CI, 48–69), P = 0.0026
    • After R-FC 5-year OS: 57% (95% CI, 44–68) vs 54% (95% CI, 39–66), P = 0.60

 The study found that therapy with R-CHOP followed by R-maintenance showed significantly increased PFS and OS in elderly MCL patients as first-line therapy. The authors noted that R-FC had a higher cumulative incidence of death from treatment-related complications, which they suggested undermined its value in induction therapy.

References
  1. Hoster E. et al. Rituximab Maintenance after First-Line Immunochemotherapy in Mantle Cell Lymphoma: Long-Term Follow-up of the Randomized European MCL Elderly Trial. Oral Abstract #153: ASH 59th Annual Meeting and Exposition, December 2017, Atlanta, GA.