Category: Lymphoma News

Lymphoma Physicians Discuss Lenalidomide Plus Rituximab as Initial Mantle Cell Lymphoma Treatment

Recently Dr. John Leonard was interviewed by the Lymphoma Research Foundation and answered questions about the current state of treatment for patients with mantle cell lymphoma (MCL). Specifically, they discussed how results from the 2015, New England Journal of Medicine published study, “Lenalidomide plus Rituximab as Initial Treatment for Mantle Cell Lymphoma” has improved the treatment options for MCL patients. This multi-center phase 2 study showed that a combination therapy, lacking many of the typical debilitating effects of traditional cancer treatment could effectively manage MCL by inducing remissions in the vast majority of patients.

Dr. Leonard, the study’s senior author, described the potential impact of this research and how it could improve our understanding of MCL and treatment as follows,

“This research provides an additional option for patients with MCL and represents the first study of a non-chemotherapy approach that is generally of lower intensity than usual initial treatment. The fact that the majority of patients had durable disease control, with good quality of life, suggests that this approach may have value for some patients. Ongoing research will better assess the longer term outcomes with this approach, and how it either compares with or can be combined with other treatments. This study demonstrates the value of potentially using newer agents as part of initial treatment in MCL, rather than holding off until the disease recurs later.”

In April 2016 the study was nominated by the Clinical Research Forum as one of their Top 10 Clinical Research Achievement Awards of 2016. The 10 winning papers were chosen based on their degree of innovation from a pool of more than 40 nominations from 30 research and academic health centers nationwide.

In the video below you can watch the study’s lead author Dr. Jia Ruan describe the importance of her team’s findings.

Treating Mantle Cell Lymphoma: Why Are Patients Benefitting From New Therapies?

Picture1By Peter Martin, MD

Most clinicians and researcher agree since mantle cell lymphoma (MCL) was first described 25 years ago patient outcomes have improved considerably. What remains unknown, however, is why outcomes are improving.

In an international, phase III clinical trial from the European MCL Network that was recently published in The Lancet, investigators demonstrated that progression-free survival could be doubled by the addition of rituximab, dexamethasone, cytarabine, cisplatin (R-DHAP) to standard chemotherapy and autologous stem cell transplantation. Whereas in the early 1990s, data suggested that patients might expect to live for 2-4 years, new findings demonstrated that patients can achieve decade long remissions. The strange thing about this remarkably positive study is that the overall survival was similar in both arms despite significant differences in virtually all other outcome measures. In fact, in the vast majority of MCL related phase III trials, despite great improvements in depth and duration of response, the overall survival of the experimental and control arms is the same.

While we celebrate the successes that each of these studies represents, important questions remain. Why are the patients in the control arms doing so well? Why are patients treated with the older, less effective therapies living as long as patients randomized to receive new therapies, and why are they living longer than patients receiving those therapies a couple decades ago?

Some of these questions can be answered by perception biases and advances in supportive care. For example, if patients in 2016 are being diagnosed with MCL earlier than they might have been diagnosed in the 1990s, they would appear to live longer, a phenomenon known as lead-time bias. Improvements in pathology may also lead to what is known as selection bias. Previously, patients with less aggressive variants of MCL were misdiagnosed as having other kinds of lymphoma, while a more representative sample is included in today’s studies. Similarly, perhaps people enrolled in recent clinical trials are healthier than they were in the past, another form of selection bias. Perhaps supportive care has improved, allowing people to live longer with lymphoma, or tolerate therapies that might have been considered overly aggressive in the past. If any or all of these hypotheses are true, hematologists around the world cannot claim credit for the perceived improvements.

It is clear that people with MCL are living longer with a higher quality of life. They have more options for treatment and these gains are due to clinical trials. In the past decade, the use of rituximab has expanded while bortezomib, temsirolimus, ibrutinib, and lenalidomide, all better tolerated than many historical options, have been approved. If this is true, it suggests that the path to continued improvements relies on the development of new, well-tolerated approaches, and it suggest that front-line therapies without curative potential must evolve to become less toxic so that subsequent lines of therapy remain feasible.

Dr. John Leonard Discusses Chimeric Antigen Receptor (CAR) T-cell Therapy for Patients with Advanced B-Cell Lymphoma

In an article from Healio HemOnc Today, Lymphoma Program Director Dr. John Leonard commented on a study presented at the 2016 ASCO meeting, which reported that for patients with advanced B-cell lymphoma, remission could be induced through a combination of low-dose chemotherapy and genetically modified T-cells. These genetically modified T-cells are known as chimeric antigen receptor (CAR) T-cells. They are modified to specifically target the CD-19 proteins found on the surface of B-cells. On the findings of the study he said,

“These represent additional data that show that this treatment regimen has potential in the treatment of patients with resistant, aggressive lymphoma. As far as follow-up is concerned, we need additional studies with larger groups of patients, with longer follow-up periods, to see if these responses are going to be durable.”

Look to this space for additional information on CAR T-cell therapy at Weill Cornell Medicine.