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Leo I. Gordon, MD, FACP


Induction Regimens for Older Patients With Mantle Cell Lymphoma

By: Joshua D. Madera, MS
Posted: Wednesday, August 17, 2022

Management of elderly patients with mantle cell lymphoma who are in remission can be a challenge for clinicians, with the vast number of induction treatment options available. Brad Kahl, MD, of the Siteman Cancer Center, St. Louis, attempted to shed some light on the selection process among these induction regimens for this patient population in a presentation at the 2022 Pan Pacific Lymphoma Conference. Although previous strategies have focused on nonintensive induction regimens, current studies are providing efficacious data on the use of intensive induction regimens for this patient population, he explained.

Noninvasive induction regimens for the management of mantle cell lymphoma have included combination treatment with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP); rituximab plus cyclophosphamide, doxorubicin, bortezomib, and prednisone (VR-CAP); bendamustine and rituximab (BR); and rituximab, bendamustine, and cytarabine (RBAC500). These regimens have shown favorable overall response rates of 89%, 92%, 90%, and 91%, respectively. Additionally, they have also provided extended durations of progression-free survival of 14.4 months, 24.7 months, between 35 to 42 months, and more than 7 years, respectively. For patients with highly proliferative disease demonstrated on Ki67 staining, the use of RBAC500 or VR-CAP may be preferred, noted Dr. Kahl.

Current efforts are focused on the use of maintenance rituximab therapy after treatment with BR, which may lead to improved outcomes for these patients. However, the optimal duration of treatment for maximal response is still being investigated.

Additionally, the double-blind, placebo-controlled, phase III SHINE study has expanded on the previously mentioned treatment regimen with the addition of the Bruton’s tyrosine kinase inhibitor ibrutinib. The addition of ibrutinib resulted in a significant improvement in median progression-free survival (80.6 months vs. 52.9 months with maintenance rituximab plus BR) and a 25% decrease in the relative risk of disease progression or death. However, no significant difference in overall survival was identified, suggesting additional efforts in establishing an effective treatment regimen are warranted.

Disclosure: Dr. Kahl has served as a consultant to AbbVie, Acerta, AstraZeneca, ADCT, BeiGene, BMS, Genentech, Genmab, Gilead, Incyte, Janssen, MEI, MorphoSys, and Pharmacyclics and has received research funding from Genentech, ADCT, Acerta, Celgene, and BeiGene.

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