# TRIANGLE

Source: https://onco.cc/trials/triangle/  
OnCo record `triangle` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

TRIANGLE showed that adding the pill ibrutinib to the chemotherapy given to younger people with mantle cell lymphoma keeps the disease away for longer, and that when ibrutinib is used the stem cell transplant that used to be compulsory no longer adds a clear benefit while adding side effects.

## Summary

TRIANGLE was a three-arm open-label phase 3 trial of the European Mantle Cell Lymphoma Network in 870 patients aged 18 to 65 with untreated stage II to IV mantle cell lymphoma, randomised to standard R-CHOP/R-DHAP induction and autologous transplant (arm A), the same with ibrutinib during R-CHOP cycles and for two years of maintenance (arm A+I), or ibrutinib-containing induction and maintenance without transplant (arm I). The primary endpoint was failure-free survival.

After 31 months of median follow-up, three-year failure-free survival was 88 percent in arm A+I against 72 percent in arm A (hazard ratio 0.52), while superiority of arm A over arm I was not shown (72 against 86 percent); the comparison of A+I against I continues. Grade 3 to 5 haematological adverse events and infections during maintenance were far more frequent after transplant plus ibrutinib than with ibrutinib alone. The corpus's mantle cell lymphoma page cites TRIANGLE for the conclusion that transplant no longer adds benefit when ibrutinib is used.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-22
- Also known as: MCL Younger 2; European MCL Network TRIANGLE
- Tags: soc-trials
- Registry id: NCT02858258
- Phase: 3
- Setting: Previously untreated mantle cell lymphoma in patients up to 65 fit for transplant: alternating R-CHOP and R-DHAP induction followed by autologous transplant (arm A), the same with ibrutinib added to induction and as two-year maintenance (arm A+I), or ibrutinib-containing induction and maintenance without transplant (arm I)
- Sponsor: European Mantle Cell Lymphoma Network (LMU Klinikum, Munich)
- Enrolled: 870
- Result: Three-year failure-free survival 88 percent with ibrutinib added to induction, transplant and maintenance against 72 percent with standard induction and transplant (hazard ratio 0.52); transplant was not shown to be superior to an ibrutinib-containing regimen without transplant (72 against 86 percent).
- Outcomes: Failure-free survival at 3 years, arm A+I against arm A: Arm A+I: R-CHOP/R-DHAP + ibrutinib, transplant, ibrutinib maintenance 88% vs Arm A: R-CHOP/R-DHAP and autologous transplant 72%, HR 0.52; Failure-free survival at 3 years, arm A against arm I (superiority of transplant not shown): Arm A: R-CHOP/R-DHAP and autologous transplant 72% vs Arm I: R-CHOP/R-DHAP + ibrutinib, ibrutinib maintenance, no transplant 86%, HR 1.77; Grade 3 to 5 haematological adverse events during maintenance or follow-up: Arm A+I 50% vs Arm I 28% vs Arm A 21%; Grade 3 to 5 infections during maintenance or follow-up: Arm A+I 25% vs Arm I 19% vs Arm A 13%

## Sources

- ClinicalTrials.gov NCT02858258: https://clinicaltrials.gov/study/NCT02858258

## Connected records

- cancers: [Mantle cell lymphoma](https://onco.cc/cancers/mantle-cell-lymphoma/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/)
- technologies: [Autologous stem cell transplant (high-dose therapy)](https://onco.cc/technologies/autologous-stem-cell-transplant/), [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Small-molecule kinase inhibitors](https://onco.cc/technologies/kinase-inhibitors/)
- drugs: [Cisplatin](https://onco.cc/drugs/cisplatin/), [Cyclophosphamide](https://onco.cc/drugs/cyclophosphamide/), [Cytarabine](https://onco.cc/drugs/cytarabine/), [Doxorubicin](https://onco.cc/drugs/doxorubicin/), [Ibrutinib](https://onco.cc/drugs/ibrutinib/), [Prednisone](https://onco.cc/drugs/prednisone/), [Rituximab](https://onco.cc/drugs/rituximab/), [Vincristine](https://onco.cc/drugs/vincristine/)
- institutions: [LMU Klinikum München](https://onco.cc/institutions/lmu-munich/)
- 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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