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.
Weill Cornell’s Dr. Rebecca Elstrom is attending the 11th International Conference on Malignant Lymphoma in Lugano, Switzerland and provides this update:
Researchers from MD Anderson Cancer Center reported results of a study of the combination of rituximab and lenalidomide in relapsed and refractory mantle cell lymphoma (MCL) at the 11th International Conference on Malignant Lymphoma on Thursday, June 16. The study included 52 patients treated on a combined phase 1/phase II study. The researchers found that more than half (57.8%) of patients responded to treatment, and most responses lasted for at least 18 months. The combination was very well tolerated, with few bothersome side effects. These results are striking for this group of patients, especially as many had not responded to previous therapy.
The combination of rituximab and lenalidomide is of interest because both drugs work, at least in part, by promoting the patient’s immune system to destroy lymphoma cells, and laboratory studies have suggested that each drug may make the other work better. In addition to mantle cell lymphoma, this combination is being investigated in other B-cell lymphoma subtypes.
Weill Cornell Medical Center is conducting a study of the combination of rituximab and lenalidomide in follicular lymphoma. The study is sponsored by The Cancer and Leukemia Group B (CALGB) and is being led at Weill Cornell by Dr. Elstrom. (Update: this study is closed to enrollment.)
By Peter Martin, MD
Patients with diffuse large B-cell lymphoma (DLBCL) that has relapsed following first-line chemotherapy are typically offered second-line chemotherapy followed by autologous stem cell transplantation (bone marrow transplantation using the patient’s own stem cells).
The CORAL study, a recently completed international phase 3 trial, evaluated whether rituximab following the transplant procedure could improve patient outcomes. The results of the study were recently presented at the American Society of Clinical Oncology (ASCO) annual meeting.
Following second-line chemotherapy (R-ICE or R-DHAP) and stem cell transplant, 242 patients were randomized to receive rituximab given every two months for one year or observation. By four years, there was no difference in rate of progression or survival between the two groups. Interestingly, women that received rituximab maintenance did considerably better than men that received rituximab maintenance while there was no difference in outcomes between the two genders in the observation group.
Based on these results, there does not appear to be an advantage to rituximab maintenance following stem cell transplantation for DLBCL.
Click here to read the abstract of the CORAL study results as presented at the ASCO annual meeting.