A multicenter retrospective comparison of induction chemoimmunotherapy regimens on outcomes in transplant-eligible patients with previously untreated mantle cell lymphoma

Zi Yun Ng, Mark Bishton, David Ritchie, Robert Campbell, Michael Gilbertson, Kate Hill, Sumita Ratnasingam, Anthony Schwarer, Kate Manos, Sophie Shorten, Melissa Ng, Niles Nelson, Liu Xin, Sanjay De Mel Widanalage, Tenny Sunny, Duncan Purtill, Michelle Poon, Anna Johnston, Tara Cochrane, Hui-Peng Lee & 6 others Greg Hapgood, Constantine Tam, Stephen Opat, Eliza Hawkes, John Seymour, Chan Yoon Cheah

Research output: Contribution to journalArticle

Abstract

Mantle cell lymphoma (MCL) is an uncommon and typically aggressive form of lymphoma. Although often initially chemosensitive, relapse is common. Several induction and conditioning regimens are used in transplant-eligible patients, and the optimal approach remains unknown. We performed an international, retrospective study of transplant-eligible patients to assess impact of induction chemoimmunotherapy and conditioning regimens on clinical outcomes. We identified 228 patients meeting inclusion criteria. Baseline characteristics were similar among the induction groups except for some variation in age. The type of induction chemoimmunotherapy received did not influence overall response rates (ORRs) (0.43), progression-free survival (PFS) (P > .67), or overall survival (OS) (P > .35) on multivariate analysis (PFS and OS). Delivery of autologous stem cell transplant (ASCT) was associated with favorable PFS and OS (0.01) on univariate analysis only; this benefit was not seen on multivariate analysis-PFS (0.36) and OS (0.21). Compared with busulfan and melphalan (BuMel), the use of the carmustine, etoposide, cytarabine, melphalan (BEAM)-conditioning regimen was associated with inferior PFS (HR = 2.0 [95% CI 1.1-3.6], 0.02) but not OS (HR = 1.1 [95% CI 0.5-2.3], 0.81) on univariate analysis only. Within the limits of a retrospective study and modest power for some comparisons, type of induction therapy did not influence ORR, PFS, or OS for transplant-eligible patients with MCL. International efforts are required to perform randomized clinical trials evaluating chemoimmunotherapy induction regimens.

Original languageEnglish
Pages (from-to)253-260
Number of pages8
JournalHematological Oncology
Volume37
Issue number3
DOIs
Publication statusPublished - Aug 2019

Cite this

Ng, Zi Yun ; Bishton, Mark ; Ritchie, David ; Campbell, Robert ; Gilbertson, Michael ; Hill, Kate ; Ratnasingam, Sumita ; Schwarer, Anthony ; Manos, Kate ; Shorten, Sophie ; Ng, Melissa ; Nelson, Niles ; Xin, Liu ; Widanalage, Sanjay De Mel ; Sunny, Tenny ; Purtill, Duncan ; Poon, Michelle ; Johnston, Anna ; Cochrane, Tara ; Lee, Hui-Peng ; Hapgood, Greg ; Tam, Constantine ; Opat, Stephen ; Hawkes, Eliza ; Seymour, John ; Cheah, Chan Yoon. / A multicenter retrospective comparison of induction chemoimmunotherapy regimens on outcomes in transplant-eligible patients with previously untreated mantle cell lymphoma. In: Hematological Oncology. 2019 ; Vol. 37, No. 3. pp. 253-260.
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abstract = "Mantle cell lymphoma (MCL) is an uncommon and typically aggressive form of lymphoma. Although often initially chemosensitive, relapse is common. Several induction and conditioning regimens are used in transplant-eligible patients, and the optimal approach remains unknown. We performed an international, retrospective study of transplant-eligible patients to assess impact of induction chemoimmunotherapy and conditioning regimens on clinical outcomes. We identified 228 patients meeting inclusion criteria. Baseline characteristics were similar among the induction groups except for some variation in age. The type of induction chemoimmunotherapy received did not influence overall response rates (ORRs) (0.43), progression-free survival (PFS) (P > .67), or overall survival (OS) (P > .35) on multivariate analysis (PFS and OS). Delivery of autologous stem cell transplant (ASCT) was associated with favorable PFS and OS (0.01) on univariate analysis only; this benefit was not seen on multivariate analysis-PFS (0.36) and OS (0.21). Compared with busulfan and melphalan (BuMel), the use of the carmustine, etoposide, cytarabine, melphalan (BEAM)-conditioning regimen was associated with inferior PFS (HR = 2.0 [95{\%} CI 1.1-3.6], 0.02) but not OS (HR = 1.1 [95{\%} CI 0.5-2.3], 0.81) on univariate analysis only. Within the limits of a retrospective study and modest power for some comparisons, type of induction therapy did not influence ORR, PFS, or OS for transplant-eligible patients with MCL. International efforts are required to perform randomized clinical trials evaluating chemoimmunotherapy induction regimens.",
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Ng, ZY, Bishton, M, Ritchie, D, Campbell, R, Gilbertson, M, Hill, K, Ratnasingam, S, Schwarer, A, Manos, K, Shorten, S, Ng, M, Nelson, N, Xin, L, Widanalage, SDM, Sunny, T, Purtill, D, Poon, M, Johnston, A, Cochrane, T, Lee, H-P, Hapgood, G, Tam, C, Opat, S, Hawkes, E, Seymour, J & Cheah, CY 2019, 'A multicenter retrospective comparison of induction chemoimmunotherapy regimens on outcomes in transplant-eligible patients with previously untreated mantle cell lymphoma' Hematological Oncology, vol. 37, no. 3, pp. 253-260. https://doi.org/10.1002/hon.2618

A multicenter retrospective comparison of induction chemoimmunotherapy regimens on outcomes in transplant-eligible patients with previously untreated mantle cell lymphoma. / Ng, Zi Yun; Bishton, Mark; Ritchie, David; Campbell, Robert; Gilbertson, Michael; Hill, Kate; Ratnasingam, Sumita; Schwarer, Anthony; Manos, Kate; Shorten, Sophie; Ng, Melissa; Nelson, Niles; Xin, Liu; Widanalage, Sanjay De Mel; Sunny, Tenny; Purtill, Duncan; Poon, Michelle; Johnston, Anna; Cochrane, Tara; Lee, Hui-Peng; Hapgood, Greg; Tam, Constantine; Opat, Stephen; Hawkes, Eliza; Seymour, John; Cheah, Chan Yoon.

In: Hematological Oncology, Vol. 37, No. 3, 08.2019, p. 253-260.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A multicenter retrospective comparison of induction chemoimmunotherapy regimens on outcomes in transplant-eligible patients with previously untreated mantle cell lymphoma

AU - Ng, Zi Yun

AU - Bishton, Mark

AU - Ritchie, David

AU - Campbell, Robert

AU - Gilbertson, Michael

AU - Hill, Kate

AU - Ratnasingam, Sumita

AU - Schwarer, Anthony

AU - Manos, Kate

AU - Shorten, Sophie

AU - Ng, Melissa

AU - Nelson, Niles

AU - Xin, Liu

AU - Widanalage, Sanjay De Mel

AU - Sunny, Tenny

AU - Purtill, Duncan

AU - Poon, Michelle

AU - Johnston, Anna

AU - Cochrane, Tara

AU - Lee, Hui-Peng

AU - Hapgood, Greg

AU - Tam, Constantine

AU - Opat, Stephen

AU - Hawkes, Eliza

AU - Seymour, John

AU - Cheah, Chan Yoon

PY - 2019/8

Y1 - 2019/8

N2 - Mantle cell lymphoma (MCL) is an uncommon and typically aggressive form of lymphoma. Although often initially chemosensitive, relapse is common. Several induction and conditioning regimens are used in transplant-eligible patients, and the optimal approach remains unknown. We performed an international, retrospective study of transplant-eligible patients to assess impact of induction chemoimmunotherapy and conditioning regimens on clinical outcomes. We identified 228 patients meeting inclusion criteria. Baseline characteristics were similar among the induction groups except for some variation in age. The type of induction chemoimmunotherapy received did not influence overall response rates (ORRs) (0.43), progression-free survival (PFS) (P > .67), or overall survival (OS) (P > .35) on multivariate analysis (PFS and OS). Delivery of autologous stem cell transplant (ASCT) was associated with favorable PFS and OS (0.01) on univariate analysis only; this benefit was not seen on multivariate analysis-PFS (0.36) and OS (0.21). Compared with busulfan and melphalan (BuMel), the use of the carmustine, etoposide, cytarabine, melphalan (BEAM)-conditioning regimen was associated with inferior PFS (HR = 2.0 [95% CI 1.1-3.6], 0.02) but not OS (HR = 1.1 [95% CI 0.5-2.3], 0.81) on univariate analysis only. Within the limits of a retrospective study and modest power for some comparisons, type of induction therapy did not influence ORR, PFS, or OS for transplant-eligible patients with MCL. International efforts are required to perform randomized clinical trials evaluating chemoimmunotherapy induction regimens.

AB - Mantle cell lymphoma (MCL) is an uncommon and typically aggressive form of lymphoma. Although often initially chemosensitive, relapse is common. Several induction and conditioning regimens are used in transplant-eligible patients, and the optimal approach remains unknown. We performed an international, retrospective study of transplant-eligible patients to assess impact of induction chemoimmunotherapy and conditioning regimens on clinical outcomes. We identified 228 patients meeting inclusion criteria. Baseline characteristics were similar among the induction groups except for some variation in age. The type of induction chemoimmunotherapy received did not influence overall response rates (ORRs) (0.43), progression-free survival (PFS) (P > .67), or overall survival (OS) (P > .35) on multivariate analysis (PFS and OS). Delivery of autologous stem cell transplant (ASCT) was associated with favorable PFS and OS (0.01) on univariate analysis only; this benefit was not seen on multivariate analysis-PFS (0.36) and OS (0.21). Compared with busulfan and melphalan (BuMel), the use of the carmustine, etoposide, cytarabine, melphalan (BEAM)-conditioning regimen was associated with inferior PFS (HR = 2.0 [95% CI 1.1-3.6], 0.02) but not OS (HR = 1.1 [95% CI 0.5-2.3], 0.81) on univariate analysis only. Within the limits of a retrospective study and modest power for some comparisons, type of induction therapy did not influence ORR, PFS, or OS for transplant-eligible patients with MCL. International efforts are required to perform randomized clinical trials evaluating chemoimmunotherapy induction regimens.

KW - autologous stem cell transplant

KW - conditioning

KW - induction

KW - mantle cell lymphoma

KW - 15-YEAR FOLLOW-UP

KW - FREE SURVIVAL

KW - RITUXIMAB

KW - TRIAL

KW - REMISSIONS

KW - IMPACT

U2 - 10.1002/hon.2618

DO - 10.1002/hon.2618

M3 - Article

VL - 37

SP - 253

EP - 260

JO - Hematological Oncology

JF - Hematological Oncology

SN - 0278-0232

IS - 3

ER -