ASH 2022 | TRIANGLE: ibrutinib with standard treatment or without autoHSCT in younger patients with MCL

The current standard of care for young patients with mantle cell lymphoma (MCL) is high-dose cytarabine-containing immunochemotherapy followed by autologous hematopoietic stem cell transplantation (autoHSCT) and rituximab maintenance. However, the BTK inhibitor ibrutinib has shown promise, particularly in previously untreated older MCL patients. Martin Dreyling, MD, LMU University Hospital Munich, Munich, Germany, describes the structure and results of the randomized, open-label TRIANGLE trial (NCT02858258) which compared ibrutinib added to standard treatment (R-CHOP/R-DHAP), standard treatment alone, and ibrutinib-containing treatment without autoHSCT. With respect to the primary outcome of three-year failure-free survival, standard treatment (72%) was not superior to the combined treatment arm (88%) or the for ibrutinib-only arm (86%). The overall response rate was also lower in the standard treatment arm compared to the combined treatment and ibrutinib-only arms. Moreover, the complete remission (CR) rate and three-year overall survival was lower for the standard treatment arm compared to the ibrutinib-containing arms. No significant differences were observed between the two autoHSCT-containing arms with respect to the occurrence of grade 3-5 adverse events (AEs). However, during maintenance, there were substantially more grade 3-5 AEs in the combined treatment arm when compared to the separate standard treatment and ibrutinib arms. In summary, this trial demonstrated that ibrutinib showed strong efficacy with acceptable toxicity during induction and as maintenance with or without ASCT. Investigators therefore concluded that while future work is required to confirm the role of autoHSCT in ibrutinib-containing treatment, the current standard high-dose regimen is not superior to the ibrutinib-containing regimen without autoSCT, and support the use of ibrutinib for younger patients with MCL in the first-line setting. This press briefing took place at the 64th ASH Annual Meeting and Exposition congress in New Orleans, LA.

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