Treatment Options to Avoid High-Dose Cytarabine

A three-arm prospective randomized trial, published in abstract form, included 359 patients with previously untreated MCL. The trial evaluated complete remission rates after induction therapy (defined as a complete metabolic response by positron emission tomography–computed tomography, undetectable MRD by blood and bone marrow, and PFS).[11] The three treatment arms included:Summary: Although adding acalabrutinib to BR plus CR did not improve efficacy, adding acalabrutinib to BR (and avoiding cytarabine) was equally effective. Since the pivotal initial trial by the European Mantle Cell Lymphoma Network [1,2] failed to confirm OS benefit at 10 years (without post-hoc adjustments), this finding suggests that cytarabine is not a mandatory agent in some induction therapy regimens.

A three-arm prospective randomized trial, published in abstract form, included 359 patients with previously untreated MCL. The trial evaluated complete remission rates after induction therapy (defined as a complete metabolic response by positron emission tomography–computed tomography, undetectable MRD by blood and bone marrow, and PFS).[11] The three treatment arms included:Summary: Although adding acalabrutinib to BR plus CR did not improve efficacy, adding acalabrutinib to BR (and avoiding cytarabine) was equally effective. Since the pivotal initial trial by the European Mantle Cell Lymphoma Network [1,2] failed to confirm OS benefit at 10 years (without post-hoc adjustments), this finding suggests that cytarabine is not a mandatory agent in some induction therapy regimens.

BR for three cycles plus CR (high-dose cytarabine plus rituximab).

A three-arm prospective randomized trial, published in abstract form, included 359 patients with previously untreated MCL. The trial evaluated complete remission rates after induction therapy (defined as a complete metabolic response by positron emission tomography–computed tomography, undetectable MRD by blood and bone marrow, and PFS).[11] The three treatment arms included:Summary: Although adding acalabrutinib to BR plus CR did not improve efficacy, adding acalabrutinib to BR (and avoiding cytarabine) was equally effective. Since the pivotal initial trial by the European Mantle Cell Lymphoma Network [1,2] failed to confirm OS benefit at 10 years (without post-hoc adjustments), this finding suggests that cytarabine is not a mandatory agent in some induction therapy regimens.

BR plus CR plus A (acalabrutinib).

A three-arm prospective randomized trial, published in abstract form, included 359 patients with previously untreated MCL. The trial evaluated complete remission rates after induction therapy (defined as a complete metabolic response by positron emission tomography–computed tomography, undetectable MRD by blood and bone marrow, and PFS).[11] The three treatment arms included:Summary: Although adding acalabrutinib to BR plus CR did not improve efficacy, adding acalabrutinib to BR (and avoiding cytarabine) was equally effective. Since the pivotal initial trial by the European Mantle Cell Lymphoma Network [1,2] failed to confirm OS benefit at 10 years (without post-hoc adjustments), this finding suggests that cytarabine is not a mandatory agent in some induction therapy regimens.

BR plus A (omitting cytarabine).

A three-arm prospective randomized trial, published in abstract form, included 359 patients with previously untreated MCL. The trial evaluated complete remission rates after induction therapy (defined as a complete metabolic response by positron emission tomography–computed tomography, undetectable MRD by blood and bone marrow, and PFS).[11] The three treatment arms included:Summary: Although adding acalabrutinib to BR plus CR did not improve efficacy, adding acalabrutinib to BR (and avoiding cytarabine) was equally effective. Since the pivotal initial trial by the European Mantle Cell Lymphoma Network [1,2] failed to confirm OS benefit at 10 years (without post-hoc adjustments), this finding suggests that cytarabine is not a mandatory agent in some induction therapy regimens.

With a median follow-up of 27.9 months, the 1-year PFS rate was 86% for BR plus CR, 89% for BR plus CR plus A, and 87% for BR plus A. The 1-year OS rate was 94% for BR plus CR, 98% for BR plus CR plus A, and 95% for BR plus A.

A three-arm prospective randomized trial, published in abstract form, included 359 patients with previously untreated MCL. The trial evaluated complete remission rates after induction therapy (defined as a complete metabolic response by positron emission tomography–computed tomography, undetectable MRD by blood and bone marrow, and PFS).[11] The three treatment arms included:Summary: Although adding acalabrutinib to BR plus CR did not improve efficacy, adding acalabrutinib to BR (and avoiding cytarabine) was equally effective. Since the pivotal initial trial by the European Mantle Cell Lymphoma Network [1,2] failed to confirm OS benefit at 10 years (without post-hoc adjustments), this finding suggests that cytarabine is not a mandatory agent in some induction therapy regimens.

The trial was closed because of an interim futility analysis for superiority of any treatment arm. However, BR plus A was the least toxic arm.