Front-Line Bendamustine Combination Linked With Stem Cell Mobilization Failure in MCL
Bendamustine-rituximab combination increased risk for day 1 stem cell mobilization failure
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Results of a new study from British Columbia indicated that patients with mantle cell lymphoma (MCL) who received bendamustine-rituximab as a first-line therapy had almost 8 times increased risk for day 1 (D1) failure of stem cell collection for transplant compared with patients who were treated with RCHOP.1
“The impact of bendamustine in pretransplant chemotherapy regimens, not only for MCL but also for a broad range of lymphomas where it is being increasingly used, must be considered when planning stem cell mobilization strategies,” Hatem Alahwal, MPH, MBBS, of the Leukemia/Bone Marrow Transplant Program of British Columbia, Vancouver, Canada, and colleagues wrote in an abstract of the 2018 American Society of Hematology (ASH) Annual Meeting and Exposition in San Diego, California.
According to the authors, bendamustine-rituximab recently replaced RCHOP as standard first-line treatment in patients with MCL eligible or ineligible for transplant. Although retrospective studies have shown that bendamustine does not adversely affect peripheral blood stem cell mobilization, that is discordant with local experience, the researchers wrote.
To explore this further, Mr Alahwal and colleagues identified 152 patients with MCL in British Columbia treated with either bendamustine-rituximab or RCHOP as first line treatment who underwent stem cell mobilization between 2013 and 2017.
Standard mobilization has been G-CSF alone until difficulties with collection were noted with bendamustine-rituximab. Different mobilization strategies included delaying stem cell collection 2 to 3 months after bendamustine-rituximab, G-CSF plus cyclophosphamide mobilization and/or rescue plerixafor if Day 1 stem cell collection was inadequate.
Two patients who had pre-emptive plerixafor prior to D1 were excluded leaving 150 patients. Of these, 37% received bendamustine-rituximab and 63%, RCHOP.
Failure of D1 collection was significantly higher after bendamustine-rituximab compared with RCHOP (45% vs 10%; P <.001). This persisted when only those patients mobilized with G-CSF alone were included (60% vs 10%; P <.001). In addition, D1 failure was higher for patients mobilized with G-CSF compared with G-CSF and cyclophosphamide combined (60% vs 28%; P =.03).
In a multivariate analysis, front-line therapy with bendamustine-rituximab was associated with increased risk of D1 failure compared with RCHOP (odds ratio = 7.83; 95% CI, 2.7-23.1; P <.001).
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- Alahwal H, Chapani P, Villa D, et al. Bendamustine adversely affects stem cell mobilization among patients with mantle cell lymphoma (MCL): a comparison of the BR Vs RCHOP Eras in British Columbia (BC), Canada. Oral presentation at: American Society of Hematology 60th Annual Meeting & Exposition; December 1-4, 2018; San Diego, California. Abstract 4556.