ECHO trial 50-month follow-up results: ABR vs PBR in TN MCL

Updated 50-month follow-up results from the phase III ECHO trial (NCT02972840) comparing acalabrutinib + bendamustine + rituximab (ABR) vs placebo + bendamustine + rituximab (PBR) as first-line therapy in 598 patients aged ≥65 years with treatment-naïve (TN) mantle cell lymphoma (MCL) were recently presented by Michael Wang at the 67th American Society of Hematology (ASH) Annual Meeting and Exposition, December 6–9, 2025, Orlando, US. The primary endpoint was progression-free survival (PFS) per independent review committee (IRC). Time to next treatment 2 (TTNT2), defined as time from randomization to either the start of third-line therapy after discontinuation of randomized treatment or death, was assessed in the post hoc analysis. The Lymphoma Hub previously reported the primary results and high-risk subgroup analysis results from this trial.

Key data: With a median follow-up of 60.8 months, median PFS was superior with ABR vs PBR (72.5 months vs 47.8 months; hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.53–0.87; p = 0.0022); the reduction in risk of progression or death with ABR vs PBR increased from 27% (primary analysis) to 32% (updated analysis). Median TTNT2 was not reached with ABR vs 73.8 months with PBR (HR, 0.76; 95% CI, 0.59–0.98; p = 0.0341), representing a 24% reduction in risk of initiating third-line therapy or death. The safety profile remained favorable and similar between arms with longer follow-up, showing comparable cumulative rates of Grade ≥3 adverse events (AEs) between arms.

Key learning: First-line treatment with ABR significantly delayed the need for subsequent therapies and extended PFS vs PBR in older patients with TN MCL, with no new safety signals, supporting its use as a first-line therapy in this patient population.