ASH Clinical News ACN_5.7_Digital | Page 39

CLINICAL NEWS
across subgroups: Consolidative AHCT
improved PFS for all groups, but im-
proved OS only in patients with higher-
risk disease, in those who received
CHOP-like induction, who had blastoid
or pleomorphic morphology, or who had
not received cytarabine with induction
( TABLE 2 ).
The researchers also conducted a
propensity-score weighted (PSW) analysis
to reduce inherent biases of retrospective
analyses and control for disease severity.
Of the 1,003 patients included in the
PSW analysis, consolidative AHCT
again prolonged PFS (78 months
vs. 48.5 months; HR=0.70; 95% CI
0.59-0.84; p<0.05), but there was no
statistically significant improvement
in OS (147 months with AHCT vs.
138 months without; HR=0.87; 95%
CI 0.69-1.10; p=0.24).
“Our study showed a PFS benefit
but did not find an OS benefit,” Dr.
Barta reported. “This calls into ques-
tion whether all young and fit patients
with newly diagnosed MCL need to
receive an AHCT post-induction.”
While certain patients with high-risk
factors may benefit from an aggressive
initial therapy, he added, an aggressive
approach may not be necessary for all
patients with MCL.
In the entire cohort, 21 patients
(2%) developed acute myeloid leu-
kemia or secondary myelodysplastic
syndromes; the incidence of these
secondary malignancies did not differ
according to AHCT status (2.5% with
AHCT vs. 1.3% without; p=0.36), al-
though the study may not have been
powered to show such a difference.
The mortality rate within 100 days of
consolidative AHCT was 1.2%.
“Toxicities, both short- and long-
term, may be avoided [by foregoing
AHCT], especially as many patients
can potentially be salvaged with
modern biologic and more targeted
therapies,” Dr. Barta noted. “Our
data may inform the individualized
discussions that oncologists have
with their transplant-eligible patients
about [their treatment options].”
As the authors noted, the retro-
spective nature of the analysis lim-
ited the study’s findings. A lack of
data regarding reasons patients did
not undergo AHCT and the lack of
standardized response assessment to
induction represent other limita-
tions of the study.
“The next important step will
be to identify which patients do
not benefit from AHCT,” Dr. Barta
concluded. “Genetic studies and mea-
surement of minimal residual disease
after induction may provide impor-
tant prognostic information to direct
and inform therapy.” Prospective,
randomized clinical trials compar-
ing consolidation with or without
AHCT are currently enrolling patients
and should provide answers to these ques-
tions, he added. ●
The authors report no relevant conflicts
of interest.
REFERENCE
Gerson JN, Handorf E, Villa D, et al. Survival outcomes of younger
patients with mantle cell lymphoma treated in the rituximab era. J Clin
Oncol. 2019;37:471-80.
Factors Associated With Improved Overall Survival
in AHCT Recipients
TABLE 2.
MIPI, low- vs. high-risk
p Value
0.42 (0.30-0.60) <0.01
Nonblastoid or nonpleomorphic morphology 0.51 (0.36-0.70) <0.01
CR to induction 0.51 (0.38-0.68) 0.01
Maintenance rituximab 0.59 (0.42-0.82) <0.01
MIPI = Mantle Cell Lymphoma International Prognostic Index; CR = complete response
W H AT
M AT T E R S
MOST TO
YOUR PATIENTS?
SEE HOW WE CAN HELP AT
KYPROLIS-HCP.COM
© 2019 Amgen Inc. All rights reserved. Not for reproduction. USA-171-80671 March 2019 Printed in USA
ASHClinicalNews.org
Hazard Ratio (95% CI)