Published in:
Open Access
08-08-2023 | Mantle Cell Lymphoma | Original Article
The addition of rituximab to chemotherapy improves overall survival in mantle cell lymphoma—a pooled trials analysis
Authors:
Luca Fischer, Linmiao Jiang, Joerg Thomas Bittenbring, Kai Huebel, Christian Schmidt, Johannes Duell, Bernd Metzner, Juergen Krauter, Bertram Glass, Andreas Huettmann, Kerstin Schaefer-Eckart, Elisabeth Silkenstedt, Wolfram Klapper, Wolfgang Hiddemann, Michael Unterhalt, Martin Dreyling, Eva Hoster, on behalf of the German Lymphoma Alliance (GLA) and the German Low-Grade Lymphoma Study Group (GLSG)
Published in:
Annals of Hematology
|
Issue 10/2023
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Abstract
Mantle cell lymphoma (MCL) is a distinct subtype of B-cell lymphoma and commonly used induction immunochemotherapies include the anti-CD20 antibody rituximab. However, efficacy data for rituximab regarding overall survival (OS) in first line MCL therapy remain conflicting.
We report long-term outcomes of a pooled trials analysis comparing Cyclophosphamide, Doxorubicine, Vincristine, Prednisone (CHOP) to R-CHOP in MCL to confirm efficacy on failure free survival (FFS) and OS in relevant subgroups. Untreated, adult MCL patients of two prospective trials assigned to CHOP or R-CHOP were included. Primary endpoints were FFS and OS, secondary endpoints included duration of response (DOR), secondary malignancies and OS after relapse. Between 1996 and 2003, 385 MCL patients were assigned to CHOP (201) or R-CHOP (184). After a median follow-up of 13.4 years, the addition of Rituximab significantly improved FFS (1.36 vs. 2.07 years, HR 0.62 (0.50–0.77)), OS (4.84 vs. 5.81 years, HR 0.78 (0.61–0.99)) and DOR (1.48 vs. 2.08 years, HR 0.67 (0.53–0.86)). Furthermore, Rituximab improved survival across different MCL risk groups. In a post-hoc analysis of OS after relapse comparing patients receiving chemotherapy with / without rituximab, rituximab maintained efficacy with a median OS of 3.10 vs. 2.11 years (HR 0.70, 0.54–0.91). The rate of secondary malignancies was 0.5 and 3.9% for hematological and 7 and 8% for non-hematological malignancies for CHOP and R-CHOP patients, respectively. We present mature results of a pooled MCL cohort, demonstrating prolonged FFS, OS and DOR for the combined immuno-chemotherapy, confirming the standard of care in first line treatment.