Rituximab Maintenance Failure In Mantle Cell Lymphoma Is Associated With High Risk Of Death: Analysis Of The Czech Lymphoma Study Group (Clsg)

Background: Mantle cell lymphoma (MCL) is an incurable B-cell malignancy comprising 5-10% of all non-Hodgkin lymphomas. Induction strategy is based on an intensive immunochemotherapy (Ara-C containing regimens) with autologous stem cell transplant (ASCT) consolidation in younger or on R-CHOP / R-Bendamustine in the elderly patients. The response rate to the induction therapy is high but majority of the patients relapse and their outcome remains unsatisfactory. Indeed, there is a need to control and/or eradicate residual lymphoma population. Several maintenance strategies using bortezomib, ibrutinib, lenalidomide or rituximab have been evaluated. Maintenance with rituximab (RM) was found to improve survival in patients treated both inside the clinical trials after intensive induction (LeGouill; ASH 2016 #145) or R-CHOP (Kluin-Nelemans et al., NEJM 2012) and also in a population-based setting (Obr et al., Klener et al. ICML 2017, #209, #210). Predictors of the RM failure remains unclear.