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Jeremy S. Abramson, MD, MMSc
Jeremy S. Abramson, MD, MMSc
Posted: Tuesday, January 21, 2025
The TRIANGLE trial, conducted by Martin Dreyling, MD, of LMU University Hospital of Munich, and colleagues, established an effective standard-of-care treatment regimen for younger patients with mantle cell lymphoma by adding the Bruton’s tyrosine kinase inhibitor ibrutinib to induction chemoimmunotherapy and maintenance. Since the efficacy comparison of two treatment arms with and without autologous stem cell transplantation (ASCT) was not complete during the first analysis, the investigators presented these results during the 2024 American Society of Hematology (ASH) Annual Meeting & Exposition (Abstract 240).
“The results confirm [the] superiority of ibrutinib-containing treatment without ASCT over ASCT-containing treatment without ibrutinib in terms of [survival],” the study authors concluded. “According to the predefined decision strategy, ibrutinib plus R-CHOP [rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone] plus R-DHAP [rituximab, dexamethasone, cytarabine, cisplatin] induction followed by 2 years of ibrutinib maintenance should be the new standard of care in younger mantle cell lymphoma patients, thus ending the era of ASCT for [these] patients.”
This open-label trial enrolled 870 patients with previously untreated, advanced, stage II to IV mantle cell lymphoma, with a median age of 57 years. Most patients (87%) had stage IV disease. Participants were randomly assigned to receive six alternating cycles of R-CHOP as well as R-DHAP (arm A, n = 288), R-CHOP plus ibrutinib (arm B, n = 292), and ibrutinib as maintenance (arm C, n = 290). Patients in arms A and B who responded to induction therapy eventually underwent ASCT.
The median follow-up was 53 months. Chemotherapy plus ibrutinib did not demonstrate failure-free survival superiority over ibrutinib maintenance (86% vs 85%), but the survival in the ibrutinib group was better than that of chemotherapy alone (75%). Of note, the two-sided P value that was calculated retrospectively suggested failure-free survival superiority of ibrutinib over chemotherapy (P = .0102). Overall survival was also significantly extended in arms B and C at 90% and 91%, respectively.
Disclosure: For full disclosures of the study authors, visit ash.confex.com.
2024 ASH Annual Meeting & Exposition
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