Predictors and Implications of Rituximab Maintenance Failure in Mantle Cell Lymphoma
Patients who did not reach a first complete remission were twice as likely to fail rituximab maintenance therapy; patients who received autologous stem cell transplant had a decreased failure risk of
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Patients with mantle cell lymphoma (MCL) who fail rituximab maintenance therapy have a greatly increased risk of death, according findings being presented at the 2017 American Society of Hematology (ASH) Annual Meeting in Atlanta, Georgia.1
For this study (ClinicalTrials.gov Identifier: NCT03199066), researchers identified 297 patients with treatment-naive MCL who had a complete response (CR) or partial response (PR) after receiving an induction regimen that contained rituximab, and were then maintained on rituximab. The median patient age was 66 years, and 22.2%, 34.1%, and 43.7% of patients had low, intermediate, and high MIPI [MCL International prognostic index] scores, respectively.
After a median follow-up of 3.8 years, 31.2% and 20.1% of patients relapsed/progressed or died, respectively. The 5-year overall survival (OS) was 75% (95% CI, 0.69-0.81), and 5-year progression-free survival (PFS) was 56% (95% CI, 0.49-0.63).
Approximately 67% of relapses/progressions and 41% of deaths occurred within 2 years of initiating rituximab maintenance therapy. The 2-year PFS and OS rates after initiating rituximab maintenance were 71.6% and 88.0%, respectively.
Patients who relapsed/progressed while on rituximab maintenance therapy had a significantly worsened 2-year OS rate of 70.3% compared with 91.7% among patients who did not relapse (hazard ratio [HR], 15.0; P < .001).
Patients who did not reach a first complete remission were twice as likely to fail rituximab maintenance therapy (HR, 2.23; P < .001), and patients who received autologous stem cell transplant had a decreased failure risk of 69% (HR, 0.31, P < .001).
The authors concluded that “[i]n patients who are at risk of [rituximab maintenance] failure, an alternative maintenance strategy should be considered.”
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- Obr A, Prochazka V, Papajik T, et al. Rituximab maintenance failure in mantle cell lymphoma is associated with high risk of death: analysis of the Czech Lymphoma Study Group (CLSG). Oral presentation at: American Society of Hematology 59th Annual Meeting & Exposition; December 9-12, 2017; Atlanta, GA.