Rituximab, bendamustine, bortezomib, plus dexamethasone (RiBVD) was found to be clinically active and safe in the first-line setting for older patients with mantle cell lymphoma (MCL), according to a study published in Haematologica

Rituximab, cyclophosphamide, doxorubicin, vincristine, plus prednisone (RCHOP21) has been the standard of care for patients with MCL. Recent studies have shown that bortezomib plus rituximab-anthracycline-based regimens, as well as bendamustine plus rituximab, improved response rates and survival outcomes compared with R-CHOP. Based on these findings, the newly formed RiBVD regimen may be an option for patients with MCL. 

For this phase 2 study, researchers evaluated 74 elderly patients with MCL older than 65 or those younger than 65 who were ineligible or unwilling to undergo autologous stem cell transplantation (ASCT). 

After a median follow-up of 52 months, the 2-year progression-free survival (PFS) rate was 70%, meeting the primary outcome measure of a PFS rate of at least 65% at 18 months. By the end of treatment, the overall response rate was 84%, which included a complete response (CR)/CR unconfirmed rate of 75.5%. Of the 54 responding patients who were analyzed for peripheral blood residual disease, 87% were found to be negative. 

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The 4-year overall survival rate was 86.6%, and the patients who were blood molecular residual disease negative at treatment end was 28.6% (P<.0001). 

Analysis showed that the MCL index, fluorodeoxyglucose-positron emission tomography, or Ki67positivity (cut off of 30% or greater) were prognostic for survival. 

The most frequently reported grade 3 to 4 hematologic toxicities were neutropenia, thrombocytopenia, and lymphopenia. Grade 3 to 4 nonhematologic adverse events included fatigue, neuropathy, and infections. 

The authors concluded that “this treatment regimen is active for frontline therapy in older patients with mantle cell lymphoma, with manageable toxicity.”

Reference

Gressin R, Daguindau N, Tempescul A, et al. A phase 2 study of rituximab, bendamustine, bortezomib, plus dexamethasone for first line treatment of older patients with mantle cell lymphoma[published online August 31, 2018].Haematologica. doi: 10.3324/haematol.2018.191429