Obinutuzumab vs rituximab for transplant-eligible patients with mantle cell lymphoma

Author(s): Clémentine Sarkozy1,2,3; Mary Callanan4; Catherine Thieblemont5; Lucie Obéric6; Barbara Burroni7; Krimo Bouabdallah8; Gandhi Damaj9; Benoit Tessoulin10; Vincent Ribrag11; Roch Houot12; Franck Morschhauser13; Samuel Griolet14; Clémentine Joubert14; Victoria Cacheux15; Vincent Delwail16; Violaine Safar17; Remy Gressin18; Morgane Cheminant19; Marie-Hélène Delfau-Larue20; Olivier Hermine19; Elizabeth Macintyre21; Steven Le Gouill1,2,3
Source: Blood (2024) 144 (3): 262–271
Original Article
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Dr. Anjan Patel's Thoughts

For transplant-eligible patients with Mantle Cell Lymphoma, Obinutuzumab showed superior efficacy compared to Rituximab. These patients are uncommon, but the results of this study show that in this context O seems to beat R in every aspect, including a 5-yr PFS of 82.8 vs 66.6%, which is striking. I would consider this option for the appropriate patient.

KEY POINTS

  • O can safely be used in combination with chemotherapy and in maintenance after ASCT as frontline therapy in patients with MCL.
  • O provides better disease control than R without additional toxicity in the MCL.

ABSTRACT

Obinutuzumab (O) and rituximab (R) are 2 CD antibodies that have never been compared in a prospective randomized trial of mantle cell lymphoma (MCL). Herein, we report the long-term outcome of the LyMa-101 trial, in which newly diagnosed patients with MCL were treated with chemotherapy plus O before transplantation, followed by O maintenance (O group). We then compared these patients with those treated with the same treatment design with R instead of O (R group). A propensity score matching (PSM) was used to compare the 2 populations (O vs R groups) in terms of measurable residual disease (MRD) at the end of induction (EOI), progression-free survival (PFS), and overall survival (OS). In LyMa-101, the estimated 5-year PFS and OS after inclusion (n = 85) were 83.4% (95% confidence interval [CI], 73.5-89.8) and 86.9% (95% CI, 77.6-92.5), respectively. At EOI, patients treated in the O group had more frequent bone marrow MRD negativity than those treated in the R group (83.1% vs 63.4%; χ2, P = .007). PSM resulted in 2 sets of 82 patients with comparable characteristics at inclusion. From treatment initiation, the O group had a longer estimated 5-year PFS (P = .029; 82.8% vs 66.6%; hazard ratio [HR], 1.99; 95% confidence interval (CI), 1.05-3.76) and OS (P = .039; 86.4% vs 71.4%; HR, 2.08; 95% CI, 1.01-4.16) compared with the R group. Causes of death were comparable in the 2 groups, the most common cause being lymphoma. O before transplantation and in maintenance provides better disease control and enhances PFS and OS compared with R in transplant-eligible patients with MCL. These trials were registered at www.clinicaltrials.gov as #NCT00921414 and NCT02896582.

Author Affiliations

1Service d’hématologie, Institut Curie, Saint Cloud, France; 2Université de Versailles Saint-Quentin, Versailles, France; 3Laboratoire d’Imagerie Translationnelle en Oncologie, U1288 INSERM/Institut Curie Centre de Recherche, Paris, France; 4University of Burgundy, INSERM U1231, Unit for Innovation in Genetics and Epigenetics in Oncology, University Hospital, Dijon, France; 5Service d’Hématologie, Hôpital Saint Louis, Assistance Publique–Hôpitaux de Paris, Paris, France; 6Service d’Hématologie, Institut Universitaire du Cancer Toulouse, Oncopole, Toulouse, France; 7Service d’Anatomopathologie, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France; 8Service d’Hématologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; 9Service d’Hématologie, Centre Hospitalier Universitaire de Caen, Caen, France; 10Service d’Hématologie, Centre Hospitalier Universitaire Nantes, Nantes, France; 11Département d’Hématologie, Institut Gustave Roussy, Villejuif, France; 12Service d’Hématologie, Centre Hospitalier Universitaire Rennes, Rennes, France; 13Department of Hematology, Claude Huriez Hospital, University of Lille, EA 7365, Research Group on Injectable Forms and Associated Technologies, Lille, France; 14LYSARC, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France; 15Service d’Hématologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France; 16Service d’Hématologie, Hôpital Poitiers, Poitiers, France; 17Service d’Hématologie, Hôpital Lyon Sud, Pierre Bénite, France; 18Service d’Hématologie, Centre Hospitalier Universitaire Grenoble, Grenoble, France; 19Department of Clinical Hematology, INSERM U1163, University of Paris, Necker University Hospital, Paris, France; 20Department of Immunology, INSERM U955 Équipe 9, Institut Mondor de Recherche Biomédicale, Hospital Henri Mondor, Creteil, France; 21Laboratory of Onco-Haematology, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades, INSERM U1151, Assistance Publique–Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris, France

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