Non-High-Dose Cytarabine Chemotherapy Plus BTK Inhibitor Treatment Shows Promise Among Patients With Newly Diagnosed Mantle Cell Lymphoma

According to a real-world multicenter study published in the International Journal of Cancer, non-high-dose cytarabine chemotherapy plus Bruton’s kinase inhibitor (BTK) inhibitor treatment may be a valuable first-line therapy option for younger patients with mantle cell lymphoma (MCL). 

“Bruton tyrosine kinase inhibitors are associated with improved treatment response and survival in patients with relapsed or refractory mantle cell lymphoma (MCL). Whether similar gains are possible with first-line BTK [inhibitor] therapy in MCL, however, remains unknown,” wrote Dongfeng Zeng, MD, Daping Hospital, Army Medical University, Chongqing, China, and coauthors.

In this study, the authors analyzed the outcomes of newly diagnosed MCL patients treated with different first-line approaches, including BTK inhibitor therapies. 1261 patients with newly-diagnosed MCL were included in the analysis , including 34% who received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), 21% who received cytarabine-containing regimens, and 3% who received bendamustine and rituximab (BR) treatment. 11% of patients (n = 145) were administered BTK inhibitor-based frontline therapy, and 17% of patients received maintenance rituximab. 12% of patients < 65 years of age received autologous hematopoietic stem-cell transplantation (auto-HSCT). 

According to propensity score matching analysis, there was no significant difference found in the 2-year progression-free survival and 5-year overall survival rates in patients receiving standard high-dose immunochemotherapy followed by auto-HSCT compared to induction therapy with BTK inhibitor-based regimens without auto-HSCT among patients less than 65 years of age (72% vs 70%, P = .476; and 91% vs 84%, P = .255).

In patients older than 65 years, BTK inhibitor treatment plus BR was correlated with the lowest progression of disease within 2 years (POD24) rate (17%) compared with BR and BTK inhibitor regimens. In patients with resolved hepatitis B virus (HBV) at baseline, the HBV reactivation rate was 2.3% among those receiving anti-HBV prophylaxis, compared with 5.3% among those not receiving anti-HBV prophylaxis, and the use of BTK inhibitors was not associated with an increased risk of HBV reactivation. 

The study authors concluded, “[Non-high-dose-cytarabine chemotherapy combined with BTK inhibitors] may be a viable therapeutic strategy for younger patients." 

Source: 

Zeng D, Fang Y, Fei Y, et al. Treatment patterns and clinical outcomes of mantle cell lymphoma: A retrospective cohort study by CHOICE. Int J Cancer. 2023; 1- 10. doi:10.1002/ijc.34565