First-Line Induction Regimen Boosts Treatment Response in MCL

A first-line induction regimen that alternates VR-CAP with R-DHAP can improve treatment response in newly diagnosed patients with mantle cell lymphoma (MCL), according to a presentation at the Eleventh Society of Hematologic Oncology Annual Meeting in Houston, Texas.

Researchers from the American University of Beirut Medical Center retrospectively assessed 10 patients who had received VR-CAP alternating with R-DHAP followed by autologous hematopoietic stem cell therapy (AHSCT) and rituximab maintenance at their institution between 2017 and 2023. They found that the regimen had a high complete response (CR) rate.

Bortezomib and cytarabine induction before AHSCT have been known to improve outcomes in MCL, but the relapse rate is still high, according to the researchers. In their study, presenter Mohamad Mourad, MD, and colleagues sought to assess the performance of the pretransplant induction therapy regimen.

Of the 10 patients, three were categorized as low risk under the MCL International Prognostic Index (MIPI) and four patients were considered to be intermediate risk. Two were deemed to be high risk, while one was classified as unknown. Positron emission tomography/Computed tomography (PET/CT) was used to evaluate disease after cycle 3 and 6, with assessment of bone marrow also performed after cycle 6, if involved. All patients also received AHSCT and rituximab maintenance.

The researchers reported that 90% of the patients achieved complete remission after cycle 6. The other patient needed a second-line induction and relapsed seven months after transplantation. However, the remaining nine patients were still in remission after data were collected, and all were still alive, according to the authors. The median follow-up after AHSCT was 24.8 months.

In terms of adverse events (AEs), the most common were hematologic toxicity and neuropathy. None of the patients discontinued their treatment due to the AEs, according to the researchers.

Also, stem cells were successfully collected in seven patients after the first granulocyte-colony stimulating factor mobilization. As for the other patients, one required two attempts, one required plerixafor, and one required cyclophosphamide mobilization, according to the researchers.

“VR-CAP alternating with R-DHAP is an acceptable regimen for pretransplant induction chemotherapy in patients newly diagnosed with MCL, leading to a high CR rate and acceptable effect on stem cell yield,” the authors concluded.

Reference

Mourad M, Atoui Ali, Zahreddine A, et al. VR-CAP alternating with R-DHAP first-line induction regimen for newly diagnosed mantle cell lymphoma (MCL): a retrospective review of 10 Patients. Abstract MCL-520. Presented at the Eleventh Annual Meeting of the Society of Hematologic Oncology; September 6-9, 2023; Houston, Texas.