Adding Rituximab to CHOP Improves Clinical Outcomes in Mantle-Cell Lymphoma

Conference Correspondent - ASH 2014 - Castleman's Disease

Immunochemotherapy has become the standard of care for patients with mantel-cell lymphoma (MCL). Previously, the German Low Grade Lymphoma Study Group (GLSG) showed in a randomized trial (GLSG2000) that the addition of RTX to R-CHOP improves response rates in untreated patients with advanced-stage MCL. However, the trial was not powered to detect survival differences. Hoster and colleagues now report on the mature pooled data from 2 consecutive randomized trials (GLSG1996 and GLSG2000) to compare the long-term clinical outcome of patients with MCL who receive CHOP with or without RTX (Hoster E, et al. ASH 2014. Abstract 1752).

In this pooled analysis, 386 patients with MCL were prospectively assigned to R-CHOP (N = 185) or CHOP (N = 201). The R-CHOP group showed higher overall response (91% vs 80%, respectively) and CR rates (25% vs 15%, respectively) than the cohort receiving CHOP. The median failure-free survival was 2.1 years compared with 1.4 years, with an adjusted hazard ratio (HR) of 0.62 (95% CI, 0.50-0.78; P <.0001). After a median follow-up of 9.6 years, the median OS was 5.9 years versus 4.8 years in the R-CHOP and CHOP groups, respectively, with an adjusted HR of 0.73 (95% CI, 0.57-0.94; P = .0166) and 5-year OS rates of 57% and 48%, respectively, confirming the randomized comparison (5-year OS rates, 59% and 47%, respectively; adjusted HR, 0.74; 95% CI, 0.50-1.09).

Thus, after a nearly 10-year follow-up, pooled data of prospective GLSG trials showed prolonged survival by the addition of RTX to CHOP induction in previously untreated patients with MCL. These results confirm the recommendation for immunochemotherapy as standard treatment for MCL. Compared with previous observations, the clinical outcome for patients with MCL has improved; however, further improvement by the introduction of more potent chemotherapy (eg, high-dose cytarabine) or new targeted approaches is urgently warranted.