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Long-term analysis of the RiBVD phase II trial reveals the unfavorable impact of TP53 mutations and hypoalbuminemia in older adults with mantle cell lymphoma; for the LYSA group.
- Source :
-
Haematologica [Haematologica] 2024 Jun 01; Vol. 109 (6), pp. 1857-1865. Date of Electronic Publication: 2024 Jun 01. - Publication Year :
- 2024
-
Abstract
- Between 2011 and 2012, a phase II trial evaluated the use of the RiBVD (rituximab, bendamustine, velcade and dexamethasone) combination as first-line treatment for mantle cell lymphoma (MCL) patients over the age of 65. We have now re-examined the classic prognostic factors, adding an assessment of TP53 mutation status. Patients (N=74; median age 73 years) were treated with the RiBVD combination. Median progression-free survival (mPFS) was 79 months and median overall survival (mOS) was 111 months. TP53 mutation status was available for 54/74 (73%) patients. TP53 mutations (TP53mt) were found in 12 patients (22.2%). In multivariate analysis, among the prognostic factors (PF) evaluated, only TP53mt and an albumin level (Alb) 3.6 g/dL were independently associated with a shorter mPFS. A hazard ratio (HR) of 3.16 (1.3-9.9, P=0.014) was obtained for TP53mt versus TP53 wild-type (wt), and 3.6 (1.39-9.5, P=0.009) for Alb <3.6 g/dL versus Alb ≥3.6 g/dL. In terms of mOS, multivariate analysis identified three PF: TP53mt (HR: 5.9 [1.77-19.5, P=0.004]), Alb <3.6 g/dL (HR: 5.2 [1.46- 18.5, P=0.011]), and ECOG=2 (HR: 3.7 [1.31-10.6, P=0.014]). Finally, a score combining TP53 status and Alb distinguished three populations based on the presence of 0, 1, or 2 PF. For these populations, mPFS was 7.8 years, 28 months, and 2.5 months, respectively. Our prolonged follow-up confirmed the efficacy of the RiBVD regimen, comparing it favorably to other regimens. TP53mt and hypoalbuminemia emerge as strong PF that can be easily integrated into prognostic scores for older adult patients with MCL.
- Subjects :
- Humans
Aged
Female
Male
Aged, 80 and over
Prognosis
Rituximab therapeutic use
Rituximab administration & dosage
Treatment Outcome
Bendamustine Hydrochloride administration & dosage
Bendamustine Hydrochloride therapeutic use
Dexamethasone therapeutic use
Dexamethasone administration & dosage
Doxorubicin therapeutic use
Doxorubicin administration & dosage
Lymphoma, Mantle-Cell drug therapy
Lymphoma, Mantle-Cell genetics
Lymphoma, Mantle-Cell mortality
Lymphoma, Mantle-Cell pathology
Tumor Suppressor Protein p53 genetics
Mutation
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Antineoplastic Combined Chemotherapy Protocols adverse effects
Hypoalbuminemia etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1592-8721
- Volume :
- 109
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Haematologica
- Publication Type :
- Academic Journal
- Accession number :
- 38031755
- Full Text :
- https://doi.org/10.3324/haematol.2023.283724