R-CHOP Plus R-BAC Shows Potential as Induction Therapy for Transplant-Eligible Patients With MCL

Results from a Retrospective Analysis

The combination of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and rituximab, bendamustine, and cytarabine (R-BAC) as induction therapy yielded promising efficacy among transplant-eligible patients with mantle cell lymphoma (MCL), with all patients in a small sample size achieving a complete response and maintaining complete remission, according to a retrospective analysis published in Cancer Medicine. 

Prior research has indicated that upfront high-dose chemotherapy (HDC) with autologous stem cell transplantation (autoSCT) demonstrates high efficacy. Despite this, “the optimal induction therapy before HDC/ASCT remains controversial as no randomized controlled trials have been performed that compare the different regimens,” Yuki Shimizu, MD, Toranomon Hospital, Tokyo, Japan, and coauthors stated. 

To attempt to assess the most efficacious induction therapy for mantle cell lymphoma, the study authors performed a retrospective analysis on the clinical profiles of 10 patients who underwent R-CHOP and R-BAC induction treatment. 

Among the 10 patients analyzed in this single-center study, 1 patient discontinued R-BAC treatment due to a rash, while the remaining 9 patients successfully completed the scheduled chemotherapy courses. Notably, all patients achieved a complete response following induction therapy and subsequently underwent HDC and autoSCT. All patients maintained a state of complete remission, with a median follow-up duration of 15 months. 

Although hematological adverse events were observed in all patients, namely grade 3 or 4 neutropenia (n = 9), no documented infections were reported. There were no occurrences of fatal non-hematological adverse events associated with the R-BAC regimen. 

The study authors concluded, “R-CHOP/R-BAC may be a good induction therapy for transplant-eligible patients with mantle cell lymphoma. To the best of our knowledge, this is the first report that demonstrates the use of R-CHOP/R-BAC therapy as induction therapy prior to HDC/ASCT."

However, they continued, “The limitation of this study is the small number of cases and short observation period. A study with a larger cohort is needed to determine whether R-CHOP/R-BAC improves the long-term survival of patients with MCL.”

Source: 

Shimizu Y, Kaji D, Watanabe O, et al. Rituximab/bendamustine/cytarabine for transplant-eligible patients with mantle cell lymphoma: A retrospective study. Cancer Med. 2023; 12: 12548-12552. doi:10.1002/cam4.6114