# Rituximab after autologous stem-cell transplantation in mantle-cell lymphoma

Source: https://onco.cc/key-papers/paper-lyma-rituximab-maintenance-after-transplant-mantle-cell-nejm-2017/  
OnCo record `paper-lyma-rituximab-maintenance-after-transplant-mantle-cell-nejm-2017` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Three years of an antibody every two months after a stem cell transplant kept younger people with mantle cell lymphoma in remission longer and helped them live longer.

## Summary

A phase 3 trial in 299 patients younger than 66 at diagnosis with mantle-cell lymphoma. After four courses of R-DHAP induction (rituximab, dexamethasone, high-dose cytarabine and a platinum derivative), the overall response rate was 89 per cent and the complete response rate 77 per cent. Transplantation was performed in 257 patients, and 240 were randomised 1 to 1 to rituximab 375 mg per square metre every two months for three years or to observation after transplantation; 59 patients did not undergo randomisation. The primary endpoint was event-free survival after transplantation among randomised patients, with an event defined as progression, relapse, death, allergy to rituximab or severe infection.

At a median follow-up of 50.2 months from randomisation (range 46.4 to 54.2), four-year event-free survival was 79 per cent (95 per cent confidence interval 70 to 86) with rituximab against 61 per cent (51 to 70) with observation (p = 0.001), and four-year progression-free survival 83 per cent (73 to 88) against 64 per cent (55 to 73). Overall survival was also prolonged.

## Fields

- Kind: Key paper
- Last checked: 2026-10-01
- Also known as: LyMa; Le Gouill 2017
- Tags: lymphoma-evidence
- Journal: New England Journal of Medicine
- Year: 2017
- DOI: 10.1056/NEJMoa1701769
- Authors: Le Gouill S, Thieblemont C, Oberic L, et al.
- Findings: Four-year event-free survival was 79 per cent (95 per cent confidence interval 70 to 86) with rituximab maintenance against 61 per cent (51 to 70) with observation (p = 0.001).; Four-year progression-free survival was 83 per cent (73 to 88) against 64 per cent (55 to 73).; Rituximab maintenance prolonged overall survival as well as event-free and progression-free survival.; After four courses of R-DHAP induction the overall response rate was 89 per cent and the complete response rate 77 per cent.; Of 299 patients enrolled, 257 were transplanted and 240 were randomised.
- What it means: One of the few maintenance strategies in lymphoma that improved overall survival rather than only progression-free survival, and the reason three years of rituximab became standard after autologous transplantation in mantle cell lymphoma.
- Caveats: The event-free survival definition included allergy to rituximab and severe infection as events, which cuts both ways in a trial of rituximab.; Restricted to patients under 66 fit enough for R-DHAP and autologous transplantation.; 59 of 299 enrolled patients were never randomised, mostly because they did not reach transplantation.; TRIANGLE has since questioned whether the transplant itself is needed when ibrutinib is added, which changes the setting in which this result applies.

## Sources

- New England Journal of Medicine 2017: https://doi.org/10.1056/NEJMoa1701769
- PubMed: https://pubmed.ncbi.nlm.nih.gov/28953447/
- Europe PMC: https://europepmc.org/article/MED/28953447

## Connected records

- roadmaps: [Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting](https://onco.cc/roadmaps/lymphoma-roadmap/)
- cancers: [Mantle cell lymphoma](https://onco.cc/cancers/mantle-cell-lymphoma/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/)
- fronts: [Cell Therapy](https://onco.cc/fronts/cell-therapy/), [Immunotherapy](https://onco.cc/fronts/immunotherapy/)
- targets: [CCND1](https://onco.cc/targets/ccnd1/), [CD20](https://onco.cc/targets/cd20/)
- drugs: [Cisplatin](https://onco.cc/drugs/cisplatin/), [Cytarabine](https://onco.cc/drugs/cytarabine/), [Dexamethasone](https://onco.cc/drugs/dexamethasone/), [Rituximab](https://onco.cc/drugs/rituximab/)
- companies: [LYSA (The Lymphoma Study Association)](https://onco.cc/companies/lysa/)
- terms: [Autologous stem cell transplant (ASCT)](https://onco.cc/terms/autologous-transplant/), [Maintenance therapy](https://onco.cc/terms/maintenance-therapy/), [Stem cell transplant in lymphoma: what it is still for](https://onco.cc/terms/lymphoma-tx-transplant-role/)
- trials: [LyMa](https://onco.cc/trials/lyma/), [TRIANGLE](https://onco.cc/trials/triangle/)
- people: [Catherine Thieblemont](https://onco.cc/people/catherine-thieblemont/)
- bottlenecks: [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)
- key papers: [TRIANGLE: ibrutinib with immunochemotherapy with or without autologous transplant versus immunochemotherapy and transplant in untreated mantle cell lymphoma](https://onco.cc/key-papers/paper-triangle-ibrutinib-mantle-cell-lymphoma-dreyling-lancet-2024/)

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