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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.
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.
299 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.
This 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.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
240 randomised.
95 per cent confidence interval 70 to 86 · 51 to 70
Source73 to 88 · 55 to 73
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Event-free survival at 4 yearsprimary | Rituximab maintenance | 120 | 79% | - | 0.001 | link |
| Observation | 120 | 61% | ||||
| Progression-free survival at 4 years | Rituximab maintenance | 120 | 83% | - | - | - |
| Observation | 120 | 64% |
Shares Maintenance and consolidation in lymphoma: where it works and where it does not, TRIANGLE, CCND1, Maintenance therapy and the tag lymphoma-evidence.
Shares Maintenance and consolidation in lymphoma: where it works and where it does not, Maintenance therapy, CD20, Rituximab and the tag lymphoma-evidence.
Shares TRIANGLE, CCND1, Maintenance therapy, CD20 and the tag lymphoma-evidence.
Shares Autologous stem cell transplant (ASCT), Stem cell transplant in lymphoma: what it is still for, Cytarabine, CD20 and the tag lymphoma-evidence.
Shares Maintenance and consolidation in lymphoma: where it works and where it does not, Maintenance therapy, CD20, Rituximab and the tag lymphoma-evidence.
Shares CCND1, Maintenance therapy, CD20, Rituximab and the tag lymphoma-evidence.
Shares Maintenance and consolidation in lymphoma: where it works and where it does not, Maintenance therapy, CD20, Rituximab and the tag lymphoma-evidence.
Shares CCND1, Maintenance therapy, CD20, Rituximab and the tag lymphoma-evidence.