For a long time, the standard treatment for younger patients with newly diagnosed mantle cell lymphoma involved intensive chemotherapy, called induction therapy, followed by autologous stem cell transplant (ASCT, where the patient’s own stem cells are used), followed by maintenance therapy to help keep the cancer from coming back.
Based on recent clinical research involving Dana-Farber, that treatment regimen has become simpler. ASCT is no longer required for patients who experience deep remission after induction therapy because the research found that it does not add benefits.
“This advancement is exciting for patients because it establishes that we can forego a treatment aspect that can have potentially significant and serious side effects — and we can do it without compromising their disease remission,” says Christine Ryan, MD, Clinical Director of Dana-Farber’s Mantle Cell Lymphoma Center. “This progress demonstrates the importance of ongoing research as the field builds on prior studies and continually incorporates new treatment modalities.”
Christine Ryan, MD, Clinical Director of Dana-Farber’s Mantle Cell Lymphoma Center
Questioning a longstanding practice
Mantle cell lymphoma is a type of blood cancer that affects white blood cells. It grows and spreads quickly, so it has traditionally been treated with this intensive multi-step regimen. The regimen was adopted years ago based on clinical trial results. However, the regimen in those trials included an induction chemotherapy that is no longer used.
Today, the induction phase is a form of chemoimmunotherapy that combines chemotherapy with a drug called rituximab, a monoclonal antibody immune therapy. The maintenance therapy phase has also transitioned to rituximab.
With these advances, oncologists started to see deep remissions in which a patient’s disease becomes undetectable. They began to wonder if ASCT was still necessary.
“It was not clear if the benefit of ASCT would still hold in an era of newer chemoimmunotherapy approaches and, in particular, with the use of rituximab,” notes Ryan.
Getting an answer via clinical trials
Two clinical trials began with the aim of answering this question. One trial, called TRIANGLE, was carried out in Europe.
The other, EA4151, was carried out in the United States, led at Dana-Farber by hematologic oncologist Ann LaCasce, MD, MMSc. This trial began in 2017 and was open to patients who experienced deep remission after induction chemoimmunotherapy. Those enrolled were assigned either to standard of care with ASCT followed by rituximab maintenance or rituximab maintenance alone.
The Dana-Farber team had great success enrolling patients in the trial. Those patients helped investigators build scientific evidence showing — through the EA4151 trial plus the TRIANGLE trial results — that ASCT does not lengthen the time of mantle cell lymphoma remission.
“We are very grateful to all patients who participated in this trial,” remarks Ryan. “They have significantly helped many future patients with mantle cell lymphoma.”
Written by: Beth Dougherty