ATLANTA — Bendamustine plus rituximab is a promising first-line therapy for MALT lymphoma, according to a study presented during the 54th American Society of Hematology Annual Meeting and Exposition.

The combination of bendamustine and rituximab in first-line treatment of MALT lymphoma “achieved an overall response rate (ORR) of 100% after only 3 cycles,” reported lead author Antonio Salar, MD, of the Hospital del Mar’s Hematology Department in Barcelona, Spain. “Complete remission rate was 98% after completing treatment plan.” Of note, a large majority of patients (77%) required only 4 cycles to achieve complete remission.”

Previous studies showed that bendamustine is active in relapsed and refractory indolent lymphomas with or without anti-CD20 antibodies, suggesting that bendamustine plus rituximab (BR) might be an attractive first-line treatment for MALT lymphoma, the authors explained. A prospective phase 2 trial enrolled 60 patients during 2009 and 2010 to receive bendamustine (90mg/m2 on days 1 and 2) plus rituximab (375mg/m2 on day 1), every 28 days. Median participant age was 62 years (range, 50-72 years) and 57% of patients were female.  

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Patients were evaluated after completing 3 cycles, and if complete remission was achieved, patients received an additional cycle. If partial response was achieved, patients were administered 3 additional cycles, for a total of 6 cycles.
Complete response rate after 3 cycles was higher in patients with gastric origin in comparison with non-gastric (90% vs 64%) (multifocal cases 100%), Dr. Salar and colleagues reported. “At the end of treatment, overall response rate was 100% with complete remission/unconfirmed complete remission of 98%.”

Only two patients received fewer than 4 cycles, the authors reported. “The rituximab dose was not modified at any cycle and only 5 patients required dose reduction of bendamustine (median dose intensity: 0.98).”

During the median follow-up of 17 months, 1 patient experienced toxicity  and 1 had a relapse; 2 deaths occurred that were unrelated to treatment.

Grade 3/4 neutropenia occurred in 14% of patients, the authors reported. Grade 3/4 nonhematologic toxicities were documented in 13 patients.

“Our data demonstrated that immunochemotherapy with bendamustine and rituximab has an excellent efficacy with a low toxicity profile,  making this response-adapted schedule a foremost therapeutic strategy for this type of lymphoma,” the authors concluded.