Jurnal Internasional Follow up lima tahun lenalidomide plus rituximab sebagai pengobatan awal limfoma sel mantel
Lenalidomide plus rituximab as induction and maintenance therapy for MCL can achieve complete remission of long-lasting MRD-negative.
Side effects associated with chronic therapy are generally non-accumulative and remain manageable.
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We report a 5-year follow-up of a multicentre phase 2 study of lenalidomide plus rituximab (LR) as the initial treatment of mantle cell lymphoma (MCL). The regimen included induction and maintenance with LR doublets. Continuous treatment until development, with termination of choice after 3 years. The average age of 38 participants was 65 years, with the MCL international prognostic index score balanced between low, medium, and high risks (34%, 34%, and 32%, respectively). Twenty-seven (75%) of 36 patients who could be evaluated completed ≥3 years of study care. At a median of 64 months follow-up (range, 21-78), 3-year development-free survival (PFS) and overall survival (OS) were 80% and 90%, respectively, with PFS estimated at 5 years and OS respectively each 64% and 77%. During maintenance, hematologic side effects (AE) include asymptomatic grade 3 or 4 cytopenias (42% neutropenia, 5% thrombocytopenia, 3% anemia) and most infections level 1 or 2 managed in an outpatient setting (45% of upper respiratory tract infections , 21% urinary tract infections, 13% sinusitis, 11% cellulitis, 8% pneumonia). Nonhematologic AE, such as constitutional and inflammatory symptoms, occurs at reduced frequency and intensity compared to induction. A peripheral blood minimal residual disease (MRD) assay (clonoSEQ) showed complete MRD-negative remission in 8 of 10 subjects who had completed ≥3 years of treatment and with samples available for analysis. With longer follow-up, LR continues to show a long-lasting and safety response that can be managed as an initial induction and maintenance therapy for MCL ( ClinicalTrials.gov NCT01472562 )
- Sent July 20, 2018.
- Accepted August 24, 2018.
- © 2018 by The American Society of Hematology