ASCO Update:Bendamustine plus rituximab beats CHOP plus rituximab as first-line treatment for indolent and mantle cell lymphoma

By Peter Martin, MD

At the plenary session of the American Society of Clinical Oncology (ASCO) on Sunday, June 3, Dr. Mattias Rummel from Germany presented updated results from a phase 3 trial initially presented at the American Society of Hematology (ASH) in 2009. The study compared bendamustine plus rituximab (BR) to CHOP chemotherapy plus rituximab (R-CHOP) in over 500 patients with indolent and mantle cell lymphoma.

Now with a median follow-up period of 45 months, the updated data were consistent with the previously reported findings. Bendamustine plus rituximab (BR) was better tolerated than R-CHOP, with significantly less neutropenia, fewer infections, and no alopecia (hair loss), and was also more effective, reducing the risk of progression roughly two-fold.

Importantly, there was no difference in the rate of transformation to aggressive lymphoma, the rate of secondary malignancies, and the ability to collect stem cells. These data support the design of ongoing and planned cooperative group trials further evaluating the first-line use of BR and BR-based combinations.

In his discussion of the abstract, Dr. Michael Williams from the University of Virginia agreed that the data were promising but cautioned that a peer-reviewed publication of the data remains to be seen.

OncLive: Dr. John Leonard Discusses What’s New in DLBCL Treatment

At the 16th Annual International Congress on Hematologic Malignancies, Dr. John Leonard, the director of the Lymphoma Program at Weill Cornell Medical College, discussed several novel therapies currently under investigation for DLBCL. Today OncLive published an article, “Beyond R-CHOP-21: What’s New in Diffuse Large B-Cell Lymphoma” summarizing Dr. Leonard’s discussion.

“The current standard for patients with advanced diffuse large B-cell lymphoma (DLBCL) is R-CHOP-21 (21-day rituximab-cyclophosphamidedoxorubicin- vincristine-prednisone). However, while this regimen cures approximately two-thirds of patients, a significant fraction of patients will still relapse, and the prognosis for these patients is poor.”

Approaches being evaluated include substituting an alternate chemotherapy regimen for CHOP in combination with rituximab; R-EPOCH (rituximabetoposide- prednisone-vincristine-doxorubicin-cyclophosphamide); and adding a new agent to R-CHOP-21.

Click here to read the full article in in OncLive.

Lugano Conference: Maintenance Rituximab Improves Progression Free Survival in Mantle Cell Lymphoma

Weill Cornell’s Dr. Rebecca Elstrom attended the 11th International Conference on Malignant Lymphoma in Lugano, Switzerland and provides this update:

Maintenance rituximab improves progression free survival in patients with mantle cell lymphoma when given after rituximab in combination with chemotherapy. These results were reported at the 11th International Conference on Malignant Lymphoma this week. Dr. Kluin-Nelemans and colleagues compared R-CHOP chemoimmunotherapy to R-fludarabine/cyclophosphamide as first line treatment of patients over 60 with mantle cell lymphoma, finding R-CHOP to be superior in this group of patients. A second randomization, to rituximab maintenance or interferon, showed that the extended administration of rituximab prolonged the time to lymphoma progression by more than two years on average.

Although maintenance rituximab has been shown to prolong remissions in patients with follicular lymphoma after rituximab plus chemotherapy, this is the first time that rituximab has been shown to have a similar effect in mantle cell lymphoma, a type of lymphoma in which remissions tend to be shorter and more difficult to treat.