Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Survival ‘Excellent’ After Rituximab-Bendamustine Induction in Transplant-Eligible MCL

Key clinical point: Rituximab-bendamustine (RB) provided robust survival with less toxicity compared with a cytarabine-based induction regimen (R-hyperCVAD) in transplant-eligible patients with mantle cell lymphoma.

Major finding: Five-year progression-free survival was 66% and 62% in the RB and R-hyperCVAD arms, respectively, while 5-year overall survival was 80% and 74%.

Study details: Follow-up report on S1106, a randomized phase 2 trial including 53 patients with mantle cell lymphoma.

Disclosures: The research was supported by the National Cancer Institute, and in part by Sequenta (Adaptive Biotechnologies). Study authors reported disclosures related to Seattle Genetics, AstraZeneca, Celgene, Genentech, Millennium Pharmaceuticals, Affimed, Seattle Genetics, Pharmacyclics, and Merck, among others.

Citation:

Kamdar M et al. Blood Adv. 2019 Oct 22;3(20):3132-5.

Commentary:

The idea that an optimal therapy exists for all patients with MCL is debatable. Younger patients tolerate intensive strategies better than older patients who make up the majority of incident cases. It is less clear, however, that the capacity to tolerate a treatment is equivalent to the necessity to undergo it. A more nuanced perspective might be that multiple treatments are reasonable, each one with various pros and cons. The S1106 trial provides an idea about the pros and cons of using RB as induction therapy in young patients. The results suggest that RB may be more effective than previously appreciated when it is applied in a low-risk population. This observation is relevant to younger patients who cannot receive or do not want an intensive induction therapy. The ongoing EA4181 study is evaluating RB-based combinations as induction therapy in younger patients with treatment-naïve MCL.—Peter Martin, MD