Among younger patients with transplant-eligible mantle cell lymphoma (MCL), first-line rituximab plus bendamustine followed by autologous stem cell transplantation (ASCT) appears to be an effective treatment option, according to a retrospective analysis published in Blood Advances.

Among younger, fit patients with MCL, treatment regimens generally involve rituximab, cyclophosphamide, vincristine, and prednisone (R-CHOP) and rituximab, dexamethasone, cytarabine, and cisplatin (R-DHAP), which previous studies have suggested yields high survival rates when combined with ASCT.

Previous research has also shown, however, that combining rituximab with bendamustine may improve outcomes compared with R-CHOP among patients with MCL who are not eligible for transplant. The combination was also shown, furthermore, to reduce toxicity associated with R-CHOP.

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Thus, there is evidence that combination rituximab and bendamustine may yield superior overall outcomes to R-CHOP and R-DHAP among younger patients with MCL who are eligible for transplant.

For this retrospective study, researchers evaluated real-world evidence to determine whether rituximab plus bendamustine yields similar clinical outcomes compared with R-CHOP/R-DHAP in a population of patients with MCL who had the possibility of proceeding to ASCT and rituximab maintenance.

Overall, data from 329 patients were included; 97 patients received rituximab plus bendamustine and 232 received R-CHOP and R-DHAP. In the bendamustine and R-CHOP/R-DHAP groups, the median ages were 58 and 56 years, respectively, 90% and 82% of patients had Ann Arbor stage IV disease, and 14% and 31% of patients had B symptoms.

Analysis showed that the overall response rates in the bendamustine and R-CHOP/D-HAP groups were 90% and 94%, respectively, with 54% complete response rates in both groups; 77% and 78% of patients proceeded to ASCT.

Adjusted hazard ratios (HRs) showed that progression-free survival was similar between the groups (HR, 0.79; P =.4), and no other endpoints showed a significant difference.

“[Rituximab with bendamustine] with ASCT and [maintenance rituximab] may be a reasonable first-line strategy for younger, transplant-eligible patients with MCL,” the authors wrote in their report.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of authors’ disclosures. 


Villa D, Hoster E, Hermine O, et al. Bendamustine or high-dose cytarabine-based induction with rituximab in transplant-eligible mantle cell lymphoma. Blood Adv. 2022;6(18):5285-5294. doi:10.1182/bloodadvances.2022007371