Advances in Chemoimmunotherapy for Frontline Mantle Cell Lymphoma Treatment

At the 2023 Lymphoma, Leukemia & Myeloma Congress in New York, New York, Jia Ruan, MD, PhD, Weill Cornell Medicine, New York, New York, discusses advances in chemoimmunotherapy for the first-line treatment of patients with mantle cell lymphoma (MCL).

Transcript:

Hi, my name is Dr Jia Ruan. I'm a lymphoma [clinician] attending at Weill Cornell New York Hospital. I take care of patients with a number of different types of lymphomas, and I'm actually here attending the Lymphoma, [Leukemia &] Myeloma Conference in New York City. 

Today, we had a discussion on the initial therapy for treating patients with mantle cell lymphoma. As you know, it's a relatively uncommon subtype of B-cell non-Hodgkin lymphoma, but there's a great advancement in terms of therapeutics that has already happened in the past 2 decades, that really improved the care of treatment in the initial therapy setting. I want to touch upon maybe 3 areas of advancement. The first is improvement in chemoimmunotherapy, so how to optimize that. It started with chemotherapy induction, and therefore treatment intensity is very, very important, but that's also limiting how many patients this can potentially help with. 

So, for young patients, who [are] physically fit, they’re intensive induction regimens, and we know now that the high-dose cytarabine-inclusive regimens, such as the MCL network induction regimen with [rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone] (R-CHOP) and [rituximab, dexamethasone, cytarabine, and cisplatin] (R-DHAP) alternating regimen have shown that it improves progression-free survival (PFS) when it's given in sequence with autologous stem cell transplant (ASCT) as consolidation. 

Based on [that] knowledge, additional implementation, such as rituximab maintenance was added to the induction and the consolidation sequence, and that seems to also improve survival, both progression-free survival and overall survival. But, when you step back, looking at patients with mantle cell lymphoma, a significant amount of them actually are more elderly. So, people over the age of 65. They're not candidates for very intensive approach[es], including transplant. So, the introduction of the combination with bendamustine plus rituximab (BR) has really changed our practice, I would say, for patients across the board for mantle cell lymphoma.

In a randomized phase 3 study where bendamustine-rituximab was compared with regimens such as R-CHOP or [rituximab, cyclophosphamide, vincristine, and prednisolone] (R-CVP), it led to improved progression-free survival. I would say, on average, the median progression-free survival was between 3 to 4 years with bendamustine-rituximab induction. And, additional rituximab maintenance has been shown in community, real-world data that adds an additional 2 years of progression-free survival. We're looking at 5 to 6 years with bendamustine-rituximab induction and the rituximab maintenance. 

Source: 

Ruan J. Initial Therapy for Mantle Cell Lymphoma. Presented at Lymphoma, Leukemia & Myeloma Congress; October 18-21, 2023. New York, NY