ASH 2017 | Long term follow-up results of rituximab maintenance in elderly MCL patients after first-line immunochemotherapy

The 59^th Annual Meeting & Exposition of the American Society of Hematology (ASH) took place in Atlanta, GA, on 9–12 December,2017. On Saturday December 9^th, 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.