Ladetto hematologist: “Mantle cell lymphoma patients’ survival increases”

“Triangle study confirms that adding ibrutinib to chemotherapy improves progression-free service”

Today i patients with mantle cell lymphoma “they have some better chances of survival than 10 years ago thanks to numerous studies, including the European Triangle study, whose main objective was to verify whether the addition of ibrutinib – anticancer drug inhibitor of Bruton’s tyrosine kinase (Btk) – was able to improve the treatment prospects of patients under 65 suffering from this rare tumor”. So to Adnkronos Salute Marco Ladetto, associate professor of the Eastern Piedmont University and director of the complex Structure of Hematology of the SS Antonio e Biagio and Cesare Arrigo hospital in Alessandria, commenting on the results of the Triangle studypresented at the recent American Society of Hematology (ASH) 2022 Annual Meeting.

Study objective: To evaluate the efficacy and safety of ibrutinib in combination with standard first-line treatment (immunochemotherapy followed by autologous stem cell transplantation and rituximab maintenance) or as a replacement for autologous stem cell transplantation in younger patients with lymphoma mantle. The Rare blood cancer affects middle and old age, particularly men and usually has an aggressive course. The pathology does not heal even if some patients obtain prolonged responses after the first line of therapy. Individuals whose disease returns after the first course of treatment or who fail to respond often have a difficult course and despite recent advances the prognosis for a significant proportion of patients is poor over months to years.

“The standard treatment (chemotherapy, monocoplonal antibodies and rituximab) was studied – underlines the hematologist – and it was compared with an approach in which this therapy was strengthened by adding ibrutinib to the standard regimen and an approach in which ibrutinib was added but the autologous transplant, or stem cell autotransplantation was removed”. ibrutinib is certainly capable of significantly improving both complete response and progression-free survival of these patients. At the moment the arm containing ibrutinib-enhanced transplant does not seem superior to the arm without auto-transplant: the follow-up we have available is not sufficient to be definitively certain of this data but the study certainly demonstrates that the addition of ibrutinib in the first line of mantle cell lymphoma is certainly capable of offering an important advantage to these patients”.

The disease typically develops from the lymph nodes, but can spread to other tissues, such as bone marrow, liver, and spleen. It represents 2-10% of lymphomas and the estimated prevalence is about 1/25,000. It affects middle-aged adults and more often men (M/F ratio of 4:1). It is defined as aggressive lymphoma, in fact at diagnosis most patients present the disseminated form of the disease, characterized by diffuse lymphodenopathy (90% of cases), gastrointestinal disturbances in 60% of cases and bone marrow involvement in 55-80% of cases. cases. The first signs/symptoms of the disease can be fever and compromised general conditions (fatigue, anorexia and weight loss).

Among the therapeutic strategies are the autologous stem cell transplantationespecially in young patients, the chemo-immunotherapy and more recently the target therapies and biological drugs. “This tumor does not present specific alarm bells – underlines Ladetto – it is no coincidence that all lymphomas are defined as subtle pathologies: this in particular manifests itself with enlargement of some glands in the neck, groin and in the armpit area, other times instead it appears with completely different manifestations.

In clinical practice, the application of the Triangle study – which so far has involved “over 10 countries and has seen Italy among the main protagonists as the second enrolling nation” , according to the expert “will allow, through a series of regulatory steps, to make ibrutinib available for this category of patients”. “We still don’t know if it will allow us to eliminate autologous transplantation from therapies, and all that it entails for patients (complications related to hospitalization, aplasia, various aspects of toxicity) but we certainly know that the future will be represented by being able to pass ibrutinib not only as second and third line therapy of patients with mantle cell lymphoma but actually bring it to the first line of therapy”, he concludes.