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Lenalidomide-bendamustine-rituximab in patients older than 65 years with untreated mantle cell lymphoma
Skane Univ Hosp, Dept Oncol, SE-22185 Lund, Sweden..
Oslo Univ Hosp, Dept Oncol, Oslo, Norway..
Univ Uppsala Hosp, Dept Oncol, Uppsala, Sweden..
Helsinki Univ Hosp, Dept Hematol, Helsinki, Finland..
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2016 (English)In: Blood, ISSN 0006-4971, E-ISSN 1528-0020, Vol. 128, no 14, 1814-1820 p.Article in journal (Refereed) Published
Abstract [en]

For elderly patients with mantle cell lymphoma (MCL), there is no defined standard therapy. In this multicenter, open-label phase 1/2 trial, we evaluated the addition of lenalidomide (LEN) to rituximab-bendamustine (R-B) as first-line treatment for elderly patients with MCL. Patients >65 years with untreated MCL, stages II-IV were eligible for inclusion. Primary end points were maximally tolerable dose (MTD) of LEN and progression-free survival (PFS). Patients received 6 cycles every four weeks of L-B-R (L D1-14, B 90 mg/m(2) IV, days 1-2 and R 375 mg/m(2) IV, day 1) followed by single LEN (days 1-21, every four weeks, cycles 7-13). Fifty-one patients (median age 71 years) were enrolled from 2009 to 2013. In phase 1, the MTD of LEN was defined as 10 mg in cycles 2 through 6, and omitted in cycle 1. After 6 cycles, the complete remission rate (CRR) was 64%, and 36% were MRD negative. At a median follow-up time of 31 months, median PFS was 42 months and 3-year overall survival was 73%. Infection was the most common nonhematologic grade 3 to 5 event and occurred in 21 (42%) patients. Opportunistic infections occurred in 3 patients: 2 Pneumocystis carinii pneumonia and 1 cytomegalovirus retinitis. Second primary malignancies (SPM) were observed in 8 patients (16%). LEN could safely be combined with R-B when added from the second cycle in patients with MCL, and was associated with a high rate of CR and molecular remission. However, we observed a high degree of severe infections and an unexpected high number of SPMs, which may limit its use. This trial is registered at www.Clinicaltrials.gov as #NCT00963534.

Place, publisher, year, edition, pages
2016. Vol. 128, no 14, 1814-1820 p.
National Category
Hematology
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URN: urn:nbn:se:uu:diva-307551DOI: 10.1182/blood-2016-03-704023ISI: 000385737900008PubMedID: 27354719OAI: oai:DiVA.org:uu-307551DiVA: diva2:1047195
Available from: 2016-11-17 Created: 2016-11-17 Last updated: 2016-11-17Bibliographically approved

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Laurell, AnnaSundström, Christer
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