Dr. Karmali on Ibrutinib Maintenance Following Induction in Untreated MCL

Reem Karmali, MD, MS, assistant professor of medicine, Northwestern University Feinberg School of Medicine, discusses the preliminary results of a study which examined ibrutinib (Imbruvica) maintenance following induction in treatment-naïve patients with mantle cell lymphoma (MCL).

In the study, investigators used ibrutinib as maintenance therapy in treatment-naïve patients who required intensive induction therapy. Patients could have been treated with chemoimmunotherapy with or without an autologous stem cell transplant. Patients who achieved a partial response (PR) or complete response (CR) were enrolled on the trial and received ibrutinib as maintenance at a dose of 560 mg daily for up to 4 years or until disease progression or unacceptable toxicity, explains Karmali.

A total of 36 patients have been accrued to the trial, the majority of whom have advanced-stage disease. Fifty percent of patients have intermediate- or high-risk disease, according to the Mantle Cell Lymphoma International Prognostic Index, and 25% of patients have extranodal disease. Forty-seven percent of patients received bendamustine and rituximab (Rituxan) as induction therapy, whereas 25% received R-HyperCVAD. The remaining patients received R-CHOP with or without cytarabine-containing cycles. Following induction, 33 of 36 patients achieved a CR. Notably, half of patients did receive a transplant, adds Karmali. With the addition of ibrutinib maintenance, 1 patient who achieved a PR achieved a CR. With 19 months of follow-up, investigators note that 24 of the 36 patients remain on ibrutinib, further supporting the feasibility of the approach.