Adding ibrutinib to frontline therapy improves outcomes in transplant-eligible patients with MCL

For eligible patients with mantle cell lymphoma (MCL), consolidative autologous haematopoietic stem cell transplantation (ASCT) is a standard component of frontline therapy but is not universally used owing to resource constraints and tolerability concerns, as well as unclear benefit with improved induction, maintenance and salvage therapies. Now, data from the phase III TRIANGLE trial demonstrate that adding the BTK inhibitor ibrutinib to frontline therapy not only improves outcomes in patients undergoing ASCT, but might also avoid the need for transplantation.

In TRIANGLE, 870 patients ≤65 years of age with stage II–IV MCL were randomly assigned 1:1:1 to receive six alternating cycles of R-CHOP and R-DHAP/DHAOx followed by ASCT (group A), or the same induction immunochemotherapy plus concurrent and maintenance ibrutinib for up to 2 years either with ASCT consolidation (group A + I) or without ASCT (group I). Rituximab maintenance was permitted in all three groups according to national guidelines and was implemented in 58%, 57% and 54% of patients, respectively. The primary end point was failure-free survival (FFS).