Hematology Xagena

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Advanced-stage mantle cell lymphoma: 90Y-Ibritumomab-Tiuxetan consolidation therapy after first-line autologous stem cell transplantation

Mantle cell lymphoma ( MCL ) is an aggressive lymphoma with a dismal prognosis because of numerous relapses.
Because the most promising results have been obtained with immunochemotherapy followed by autologous cell stem transplantation ( ASCT ), researchers have evaluated the efficacy of Yttrium-90 Ibritumomab [ (90)Y-IT; Zevalin ] consolidation after such an intensive treatment.

Investigators have retrospectively assessed 57 patients affected by intermediate or high-risk mantle cell lymphoma in complete remission ( CR ) or partial remission ( PR ) after 3 cycles of R-CHOP ( Rituximab, Cyclophosphamide, Doxorubicin [ Hydroxydaunorubicin ], Vincristine [ Oncovin ], Prednisolone ) plus 3 cycles of R-DHAP ( Dexamethasone, Cytarabine [ Ara-C ], Cisplatin [ Platinum ] ) followed by ASCT and additional consolidation treatment with (90)Y-IT in 28 cases.
All patients underwent 2 years of Rituximab ( MabThera ) maintenance.

After ASCT, 94% achieved complete remission and 4% achieved partial remission.

The median follow-up was 6.2 years ( range, 1.8-9.7 years ).

Treatment intensification was well tolerated and led to a significantly longer response duration in comparison to standard treatment.

In contrast to the historical cohort, the addition of (90)Y-IT seems to overcome important risk factors such as MIPI ( Mantle Cell Lymphoma International Prognostic Index ) score and bone marrow infiltration.

In the present retrospective analysis, immunochemotherapy followed by ASCT resulted in a very high response rate, and subsequent (90)Y-IT consolidation significantly reduced the number of relapses and increased survival, suggesting that (90)Y-IT consolidation might be a valid option in first-line treatment. However, a prospective confirmatory trial is warranted. ( Xagena )

Mondello P et al, Clin Lymphoma Myeloma Leuk 2016;16:82-88