Use of Post-Induction Treatment in Mantle Cell Lymphoma (MCL) in Spain. Do All Young Fit Patients Need Autologous Stem Cell Transplantation (ASCT) in the Era of High-Dose Ara-C (HiDAC) and Rituximab Maintenance?

• Published in: Blood 2024-11, Vol.144 (Supplement 1), p.4422-4422
• Main Authors: Marin Niebla, Ana, Bastos-Oreiro, Mariana, Perez, Amanda Isabel, Cabirta Touzón, Alba, De la Cruz Vicente, Fatima, Canelo, Marta, Jiménez Ubieto, Ana, González De Villambrosia, Sonia, Muntañola, Ana, Luzardo Henríquez, Hugo Daniel, Rios Herranz, Eduardo, De La Cruz, Beatriz, Cordoba, Raul, Saus Carreres, Ana, Martín García-Sancho, Alejandro, Garcia Noblejas, Ana, Grande, Carlos, Prieto Martinez, Pablo, Nicolás, Concepción, Gutierrez, Antonio, Hernandez Rivas, Jose-Angel, Sánchez-González, Blanca, Alonso Trillo, Rosalia, Donato, Eva, Villafuerte Gutiérrez, Paola, García Belmonte, Daniel, Verdesoto Cozzarelli, Silvia Rocio, Suarez Ordoñez, Sandra, Pardal De La Mano, Emilia, Villalon Blanco, Lucia, Gine, Eva, Sancho, Juan-Manuel, Lopez Garcia, Alberto, Roldán-Pérez, Alicia, Gómez, Pilar, Navarro Garces, Victor, Abrisqueta, Pau
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2024-211078

INTRODUCTION: Consolidation with ASCT after induction immunochemotherapy (ICT) is the standard strategy in MCL to prolong progression-free survival (PFS) in young fit eligible patients since 2005. HiDAC-based ICT further improved these results and, years later, Rituximab Maintenance (RM) prolongued PFS and overall survival (OS) not only in young patients responding to HiDAC+ASCT but also in those older or non-eligible for such intensive approach, challenging the current role of ASCT consolidation in the era of HiDAC and Rituximab Maintenance. We described the post-induction management of patients with MCL in Spain and its impact on their survival, with special focus on the results of SCT and RM. PATIENTS AND METHODS: We retrospectively analyzed the clinical-biologic data, post-induction management and their impact on PFS and OS in the GELTAMO-MCL-2022 study, excluding indolent cases treated or not after observation. Post-induction treatment (PIT) was individually indicated as per clinical practice and physicians' criteria and included autologous (ASCT) or allogeneic stem cell transplant (allo-SCT) and/or Maintenance with rituximab (RM) alone or with other agent. ICT regimens were grouped as HiDAC (HD-AraC-based) or non-HiDAC. Kaplan-Meier was used to analyze survival and the COX model for HR (CI95%) and p value of factors associated with PFS and OS. RESULTS: Out of 1105 patients diagnosed from 2000-2023 in 32 Spanish centers in the GELTAMO-MCL-2022 study, 757 were in Complete or Partial Response (CR, PC) after upfront ICT and were eligible for PIT and for this analysis: 241 (32%) received RM, 150 (20%) SCT, 127 (17%) sequential SCT-RM and 239 (31.6%) received none. In the total 277 patients receiving SCT (only 6 allo-SCT), ICT was HiDAC in 85% and non-HiDAC in 15% and age was ≤65yrs in 65% vs. >65 in 10%. In 368 RM (23(6%) +BTKi or lenalidomide), ICT was HiDAC in 45% vs. 55% non-HiDAC, age was ≤65 in 47% vs. 50.6% >65 yrs, median time on RM= 24m(2-160). SCT patients (vs. non-SCT) were younger (M age 57yr [29-78]) vs. 71 yr [34-91]), more frequently men (78% vs. 29%), had died of infection (11% vs. 4%) and toxicity (28% vs. 21%) rather than progression (44% vs. 50%), had lower MIPI (LR-MIPI 39% vs. 23%), showed higher CRR after ICT (90% vs. 81%) and more L-POD (84% vs. 68%). With mFU= 89 m, mPFS in SCT vs. Non-SCT patients was 73m vs. 45m (HR=0.57, p