MCL: AHCT consolidation boosts PFS, not OS in rituximab era

  • Gerson JN & al.
  • J Clin Oncol
  • 7 Jan 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Rituximab was approved by the FDA in 1997; since then, rituximab-based chemotherapy induction regimens have become the standard of care before autologous hematopoietic cell transplantation (AHCT).
  • This large cohort of younger patients (age, ≤65 years) with mantle cell lymphoma (MCL) found that AHCT consolidation improved PFS by 30% but had no effect on OS in the rituximab era (2000-2015).

Why this matters

  • This is the first large study of survival after AHCT in the rituximab era.
  • Findings suggest that patients aged ≤65 years should undergo AHCT.

Study design

  • Retrospective multicenter (n=25) cohort of 1029 transplantation-eligible patients with newly diagnosed MCL aged ≤65 years, 657 of whom underwent AHCT and 372 of whom did not.
  • Funding: None disclosed.

Key results

  • Median follow-up was 76 months.
  • Median PFS of the entire cohort was 62 months; median OS was 138 months.
  • On multivariate analysis, AHCT (vs no AHCT) was associated with improved PFS (HR, 0.53; 95% CI, 0.43-0.66) and with a trend toward better OS (HR, 0.77; 95% CI, 0.98-1.01).
  • On propensity score-weighted analysis, AHCT continued to be associated with improved PFS (median, 78.0 vs 48.5 months; HR, 0.70; 95% CI, 0.59-0.84), yet no improved OS (median, 147 vs 138 months; HR, 0.87; 95% CI, 0.69-1.10).

Limitations

  • Retrospective design.
  • Possible selection bias.

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