Oxaliplatin before autologous transplantation in combination with high-dose cytarabine and rituximab provides longer disease control than cisplatin or carboplatin in patients with mantle-cell lymphoma: results from the LyMA prospective trial.

Abstract

LyMA trial has demonstrated the benefit of rituximab maintenance after autologous stem cell transplantation (ASCT) in previously untreated mantle-cell lymphoma patients (MCL). Induction consisted of four courses of R-DHAP (rituximab, dexamethasone, high-dose cytarabine, and platinum derivative). The platinum derivative (PD) choice was free: R-DHA-cisplatin, R-DHA-carboplatin, or R-DHA-oxaliplatin. We investigated the prognostic impact of each PD. PFS and OS calculated from inclusion and investigated in an intention-to-treat (ITT) (= 298) and per-protocol analyses (PP) (n = 227). R-DHACis, R-DHACa, or R-DHAOx were used at first cycle in 184, 76, and 38 patients, respectively. Overall, 71 patients (59 in the R-DHACis) required a change in PD, mainly because of PD toxicity. In ITT-analysis, PFS in the R-DHACis and R-DHACa groups were similar (4-year PFS of 65%), while R-DHAOx had a better PFS (4-year PFS of 65% versus 86.5%, respectively, HR = 0.44, p = 0.02). The 4-year OS was 92% for R-DHAOx versus 75.9% for R-DHACis/DHACa (HR = 0.37, p = 0.03). Similar results were yielded in the PP analysis. Low MIPI and R-DHAOx were independent favorable prognostic markers for both PFS (HR = 0.44, p = 0.035) and OS (HR = 0.36, p = 0.045). In vitro and in silico analyses confirmed that oxaliplatin has an anti-MCL cytotoxic effect that differs from that of other PD. R-DHAOx before ASCT provides better outcome in transplantation eligible young MCL patients.

• Authors: Benoit Tessoulin, David Chiron, Catherine Thieblemont, Lucie Oberic, Kamal Bouadballah, Emmanuel Gyan, Gandhi Damaj, Vincent Ribrag, Rémy Gressin, Pierre Feugier, Olivier Casasnovas, Hacène Zerazhi, François Lemonnier, Hervé Maisonneuve, Clementine Joubert, Eric Van Den Neste, Thierry Lamy, Hervé Tilly, Anne Moreau, Olivier Hermine, Steven Le Gouill
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 56 Issue 7 Pg. 1700-1709 (07 2021) ISSN: 1476-5365 [Electronic] England
• PMID: 33658645 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Cytarabine
• Oxaliplatin
• Rituximab
• Carboplatin
• Cisplatin

Topics

• Adult
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Carboplatin (therapeutic use)
• Cisplatin
• Cytarabine (therapeutic use)
• Disease-Free Survival
• Hematopoietic Stem Cell Transplantation
• Humans
• Lymphoma, Mantle-Cell (drug therapy)
• Oxaliplatin (therapeutic use)
• Prospective Studies
• Rituximab (therapeutic use)
• Transplantation, Autologous