{"entity":{"id":"lyma","kind":"trial","name":"LyMa","aka":["Rituximab maintenance after autologous transplantation in mantle cell lymphoma","LyMa trial"],"tldr":"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":"Younger patients with mantle cell lymphoma are treated intensively, with cytarabine-containing induction and an autologous stem-cell transplant, and still relapse. LyMa asked whether rituximab maintenance after the transplant changes that.\n\n299 patients under 66 at diagnosis received four courses of R-DHAP induction, after which the overall response rate was 89 per cent and the complete response rate 77 per cent. 257 were transplanted and 240 were randomised to rituximab 375 mg per square metre every two months for three years, or to observation. At a median follow-up of 50.2 months from randomisation, 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.\n\nThis is one of the few maintenance strategies in lymphoma that improved survival rather than only progression-free survival, which is why it became standard for transplanted patients. The TRIANGLE trial has since asked whether the transplant itself is still needed when ibrutinib is added to induction and maintenance.","status":"positive","asOf":"2026-10-01","links":[{"label":"ClinicalTrials.gov NCT00921414","url":"https://clinicaltrials.gov/study/NCT00921414"},{"label":"New England Journal of Medicine 2017","url":"https://doi.org/10.1056/NEJMoa1701769"}],"tags":["lymphoma-evidence"],"related":[],"cancers":["mantle-cell-lymphoma","non-hodgkin-lymphoma"],"sections":["immunotherapy","cell-therapy"],"technologies":["monoclonal-antibody"],"targets":["cd20","ccnd1"],"drugs":["rituximab","dexamethasone","cytarabine","cisplatin"],"companies":[],"institutions":[],"pathways":[],"terms":["maintenance-therapy","autologous-transplant","lymphoma-tx-maintenance","lymphoma-tx-transplant-role"],"trials":["triangle"],"people":[],"bottlenecks":["b-toxicity-qol"],"keyPapers":["paper-lyma-rituximab-maintenance-after-transplant-mantle-cell-nejm-2017"],"journals":[],"dependsOn":[],"notes":[],"nct":"NCT00921414","phase":"3","setting":"Under 66 at diagnosis with mantle cell lymphoma, after R-DHAP induction and autologous stem-cell transplantation: three years of rituximab maintenance against observation","sponsor":"French Innovative Leukemia Organisation","result":"Four-year event-free survival 79 against 61 per cent (p = 0.001) and improved overall survival with three years of rituximab maintenance after transplantation.","started":"2008-09","yearReported":2017,"enrolled":240,"enrolledBasis":"randomised","enrolledNote":"299 patients entered the trial; 257 were transplanted and 240 were randomised between maintenance and observation after transplantation.","outcomes":[{"endpoint":"Event-free survival at 4 years","primary":true,"unit":"%","arms":[{"name":"Rituximab maintenance","n":120,"value":79,"note":"95 per cent confidence interval 70 to 86"},{"name":"Observation","n":120,"value":61,"note":"51 to 70"}],"p":"0.001","source":"https://doi.org/10.1056/NEJMoa1701769"},{"endpoint":"Progression-free survival at 4 years","unit":"%","arms":[{"name":"Rituximab maintenance","n":120,"value":83,"note":"73 to 88"},{"name":"Observation","n":120,"value":64,"note":"55 to 73"}]}],"replication":"The survival benefit has not been repeated in a second randomised trial; TRIANGLE changed the induction and the transplant question rather than the maintenance question."},"route":"/trials/lyma/","neighbours":{"cancer":[{"id":"mantle-cell-lymphoma","kind":"cancer","name":"Mantle cell lymphoma","route":"/cancers/mantle-cell-lymphoma/"},{"id":"non-hodgkin-lymphoma","kind":"cancer","name":"Non-Hodgkin lymphoma (all types)","route":"/cancers/non-hodgkin-lymphoma/"}],"section":[{"id":"cell-therapy","kind":"section","name":"Cell Therapy","route":"/fronts/cell-therapy/"},{"id":"immunotherapy","kind":"section","name":"Immunotherapy","route":"/fronts/immunotherapy/"}],"technology":[{"id":"monoclonal-antibody","kind":"technology","name":"Monoclonal antibodies","route":"/technologies/monoclonal-antibody/"}],"target":[{"id":"ccnd1","kind":"target","name":"CCND1","route":"/targets/ccnd1/"},{"id":"cd20","kind":"target","name":"CD20","route":"/targets/cd20/"}],"drug":[{"id":"cisplatin","kind":"drug","name":"Cisplatin","route":"/drugs/cisplatin/"},{"id":"cytarabine","kind":"drug","name":"Cytarabine","route":"/drugs/cytarabine/"},{"id":"dexamethasone","kind":"drug","name":"Dexamethasone","route":"/drugs/dexamethasone/"},{"id":"rituximab","kind":"drug","name":"Rituximab","route":"/drugs/rituximab/"}],"term":[{"id":"autologous-transplant","kind":"term","name":"Autologous stem cell transplant (ASCT)","route":"/terms/autologous-transplant/"},{"id":"lymphoma-tx-maintenance","kind":"term","name":"Maintenance and consolidation in lymphoma: where it works and where it does not","route":"/terms/lymphoma-tx-maintenance/"},{"id":"maintenance-therapy","kind":"term","name":"Maintenance therapy","route":"/terms/maintenance-therapy/"},{"id":"lymphoma-tx-transplant-role","kind":"term","name":"Stem cell transplant in lymphoma: what it is still for","route":"/terms/lymphoma-tx-transplant-role/"}],"trial":[{"id":"triangle","kind":"trial","name":"TRIANGLE","route":"/trials/triangle/"}],"bottleneck":[{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}],"paper":[{"id":"paper-lyma-rituximab-maintenance-after-transplant-mantle-cell-nejm-2017","kind":"paper","name":"Rituximab after autologous stem-cell transplantation in mantle-cell lymphoma","route":"/key-papers/paper-lyma-rituximab-maintenance-after-transplant-mantle-cell-nejm-2017/"}],"roadmap":[{"id":"lymphoma-roadmap","kind":"roadmap","name":"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","route":"/roadmaps/lymphoma-roadmap/"}]}}