Mantle cell lymphoma: minimal residual disease outcomes
Mené en France sur 86 patients atteints d’un lymphome à cellules du manteau et éligibles à une greffe autologue de cellules souches, cet essai de phase II évalue l’efficacité, du point de vue de la négativité à la maladie résiduelle minimale, et la toxicité d’un traitement d’induction combinant obinutuzumab et une chimiothérapie de type DHAP (dexaméthasone, hautes doses de cytarabine, cisplatine)
In The Lancet Haematology, Steven Le Gouill and colleagues describe a phase 2 trial of obinatuzumab plus DHAP (dexamethasone, high-dose cytarabine, and cisplatin) as induction therapy before autologous stem-cell transplantation for patients with mantle cell lymphoma. The trial evaluated minimal residual disease negativity in bone marrow by quantitative PCR (qPCR) after induction chemotherapy and before autologous transplantation. Positive qPCR at an early timepoint could be predictive of a poor outcome with standard autologous transplantation and might allow high-risk patients to be directed to alternative therapies. In this study, 55 (75%) of 73 patients in the efficacy set reached minimal residual disease negativity in bone marrow at the end of four cycles of obinatuzumab plus DHAP. Minimal residual disease negativity for other induction regimens has been reported as 26% for R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone or prednisolone), 61% for R-CHOP alternating cycles with R-DHAP (rituximab plus DHAP), and 67% for fludarabine, cyclophosphamide, and rituximab