Until recently, the role of rituximab in treatment of mantle cell lymphoma (MCL) was unclear. Prior randomized trials demonstrated improved response rates to chemotherapy when combined with rituximab, but unlike other lymphomas, it had failed to demonstrate an improvement in survival. Two abstracts presented at the recent American Society of Hematology (ASH) meeting provided encouraging evidence regarding this most-important outcome.
Dr. Simon Rule presented the results of the recent UK National Cancer Research Institute trial comparing fludarabine/cyclophosphamide (FC) to FC plus rituximab (FCR) in patients of all ages with newly diagnosed MCL. The trial enrolled 370 patients with mostly intermediate and high-risk MCL and followed them for an average of 39 months. The addition of rituximab to FC improved response rate, complete response rate, time to progression, and overall survival. Combined with recent evidence from data registry studies and the data that has accumulated from prior trials, it is clear that standard of care first-line treatment of MCL should include rituximab.
Updated results from a European Mantle Cell Lymphoma Network trial (also presented at the meeting in Lugano last summer and discussed by Dr. Rebecca Elstrom in this blog) confirmed that rituximab maintenance administered to patients over 60 years of age after R-CHOP chemotherapy provided a significant survival benefit. Although longer follow-up and confirmatory trials are needed, rituximab maintenance may be considered standard of care for older patients not receiving more aggressive induction/consolidation regimens. The upcoming Intergroup trial for patients over 60 years of age will feature randomization between rituximab maintenance and maintenance with lenalidomide plus rituximab.