1. 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.
- Author
-
UCL - SSS/IREC/MIRO - Pôle d'imagerie moléculaire, radiothérapie et oncologie, UCL - (SLuc) Centre du cancer, UCL - (SLuc) Unité d'oncologie médicale, UCL - (SLuc) Service de gastro-entérologie, Tessoulin, Benoit, Chiron, David, Thieblemont, Catherine, Oberic, Lucie, Bouadballah, Kamal, Gyan, Emmanuel, Damaj, Gandhi, Ribrag, Vincent, Gressin, Rémy, Feugier, Pierre, Casasnovas, Olivier, Zerazhi, Hacène, Lemonnier, François, Maisonneuve, Hervé, Joubert, Clementine, Van Den Neste, Eric, Lamy, Thierry, Tilly, Hervé, Moreau, Anne, Hermine, Olivier, Le Gouill, Steven, UCL - SSS/IREC/MIRO - Pôle d'imagerie moléculaire, radiothérapie et oncologie, UCL - (SLuc) Centre du cancer, UCL - (SLuc) Unité d'oncologie médicale, UCL - (SLuc) Service de gastro-entérologie, Tessoulin, Benoit, Chiron, David, Thieblemont, Catherine, Oberic, Lucie, Bouadballah, Kamal, Gyan, Emmanuel, Damaj, Gandhi, Ribrag, Vincent, Gressin, Rémy, Feugier, Pierre, Casasnovas, Olivier, Zerazhi, Hacène, Lemonnier, François, Maisonneuve, Hervé, Joubert, Clementine, Van Den Neste, Eric, Lamy, Thierry, Tilly, Hervé, Moreau, Anne, Hermine, Olivier, and Le Gouill, Steven
- 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.
- Published
- 2021