Does TRIANGLE take down transplantation in mantle cell lymphoma?
Mené sur 870 patients atteints d'un lymphome à cellules du manteau (durée médiane de suivi : 31 mois), cet essai multicentrique randomisé de phase III évalue l'efficacité, du point de vue de la survie sans échec, et la toxicité de l'ajout de l'ibrutinib à une immunochimiothérapie avec ou sans greffe autologue de cellules souches hématopoïétiques
Autologous stem-cell transplantation (ASCT) is considered the standard of care for management of younger patients (ie, younger than 65–70 years) with newly diagnosed mantle cell lymphoma in much of the world. Once associated with a poor overall survival (only 2 years in many reports), mantle cell lymphoma has been the subject of increasingly intense investigational therapies over the past two decades. The first European Mantle Cell Lymphoma Network trial, published in 2005, showed that ASCT prolonged time to progression in younger patients with mantle cell lymphoma. 1 A subsequent trial published a decade later reported that an induction regimen containing rituximab and high-dose cytarabine followed by consolidation with ASCT resulted in a median overall survival exceeding 10 years. 2 Despite these promising data, adoption of ASCT has not been universal. In the USA, only a small proportion of people with mantle cell lymphoma thought to be eligible for ASCT undergo the procedure. In some cases, people are not offered ASCT because they do not have the resources or social support required to sustain highly intensive therapy. 3 In Sweden, unmarried or less educated patients with mantle cell lymphoma were less likely to undergo ASCT than patients who were married or had a higher level of education. 4 Some people with mantle cell lymphoma might live too far from a transplant centre or are deemed too frail to tolerate transplantation. Some people prefer to avoid intensive (and often toxic) treatment strategies. Increasingly, there are doubts regarding the benefits initially ascribed to ASCT, and the US intergroup EA4181 trial (NCT03267433) was designed to examine the issue. A large, contemporary, US retrospective study drawing from large real-world cohorts at community and academic centres alike suggested that ASCT did not appear to be associated with time to progression or overall survival in people who were likely to be eligible to receive the procedure. 3 This article is available free of charge.