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Ann Oncol. 2015 Jun;26(6):1175-9. doi: 10.1093/annonc/mdv111. Epub 2015 Feb 23.

Patients with mantle cell lymphoma failing ibrutinib are unlikely to respond to salvage chemotherapy and have poor outcomes.

Author information

1
Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, USA.
2
Department of Haematology, Peter MacCallum Cancer Center, Melbourne Department of Haematology, University of Melbourne, Melbourne, Australia.
3
Department of Stem Cell Transplantation, University of Texas MD Anderson Cancer Center, Houston, USA.
4
Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, USA miwang@mdanderson.org.

Abstract

BACKGROUND:

Although ibrutinib is highly effective in patients with relapsed/refractory mantle cell lymphoma (MCL), a substantial proportion of patients have resistant disease. The subsequent outcomes of such patients are unknown.

PATIENTS AND METHODS:

We carried out a retrospective review of all patients with MCL treated with ibrutinib at MD Anderson Cancer Center between January 2011 and January 2014 using pharmacy and clinical databases. Patients who had discontinued ibrutinib for any reason were included in the study.

RESULTS:

We identified 42 patients with MCL who discontinued therapy due to disease progression on treatment (n = 28), toxicity (n = 6), elective stem-cell transplant in remission (n = 4) or withdrawn consent (n = 4). The median age was 69 years, 35 (83%) were male; the median number of prior treatments was 2 (range 1-8) and the median time from initial diagnosis of MCL to commencing ibrutinib was 3.0 (range 0.5-15.5) years. Patients had received a median of 6.5 (range 1-43) cycles of ibrutinib. Among 31 patients who experienced disease progression following ibrutinib and underwent salvage therapy, the overall and complete response rates were 32% and 19%, respectively. After a median follow-up of 10.7 (range 2.4-38.9) months from discontinuation of ibrutinib, the median overall survival (OS) among patients with disease progression was 8.4 months. By univariate analysis, elevated serum lactate dehydrogenase at progression was associated with inferior OS.

CONCLUSION:

The outcome of patients with MCL who experience disease progression following ibrutinib therapy is poor, with both low response rates to salvage therapy and short duration of responses. Further studies to better understand and overcome ibrutinib resistance are urgently needed.

KEYWORDS:

Bruton's tyrosine kinase inhibitors; ibrutinib; mantle cell lymphoma; prognosis; treatment

PMID:
25712454
DOI:
10.1093/annonc/mdv111
[Indexed for MEDLINE]

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