Maintenance rituximab after autologous stem cell transplantation in patients with mantle cell lymphoma
Menée sur une cohorte de 157 patients ayant reçu une greffe autologue de cellules souches hématopoïétiques pour traiter un lymphome à cellules du manteau, cette étude rétrospective évalue l'efficacité, du point de vue de la survie sans progression et de la survie globale, et la toxicité du rituximab en traitement d'entretien
Background : High dose therapy and autologous stem cell transplantation (ASCT) improves outcomes for patients with mantle cell lymphoma (MCL), but relapse ultimately occurs in most patients. Recently presented interim results from a phase III prospective trial suggest maintenance rituximab (MR) after ASCT for MCL improves progression-free survival (PFS). The maturation of these data and any benefit of MR on overall survival (OS) remain to be defined. Patients and methods : In this retrospective study we examined a cohort of consecutive patients with MCL that underwent ASCT for MCL at our center and evaluated their outcomes according to whether they received MR after ASCT (n=50) or did not (n=107). MR was treated as a time dependent covariate to account for variation in timing of its initiation. Results : MR was associated with an improved progression free survival (PFS) (hazard ratio [HR] 0.44; confidence interval [CI] (0.24 – 0.80), p=0.007) and overall survival [OS] (HR 0.46; CI (0.23 – 0.93), p=0.03) following a multivariate adjustment for confounding factors with a median follow up of approximately 5 years. Grade 4 neutropenia was increased (34% versus 18%, p=0.04) in the MR group but no effect on the rate of mortality unrelated to relapse was observed. Conclusions : These data support that MR after ASCT for MCL confers a benefit in PFS and additionally suggest it may improve OS. General application of this strategy will require confirmation of benefit in prospective randomized trials.