345P - Safety and efficacy of platinum substitution in induction chemotherapy for mantle cell lymphoma

Background

While induction with cytarabine containing immuno-chemotherapy is recommended for fit patients (pts) with newly diagnosed mantle cell lymphoma (MCL), the choice of accompanying platinum agent is less clear. Substitution to carboplatin simplifies chemotherapy administration and reduces nephrotoxicity. We aimed to assess the impact of up to 6 cycles of alternating RCHOP/RDHAC (carboplatin) as induction for transplant-eligible pts with MCL prior to BEAM autologous stem cell transplant (ASCT).

Methods

Single centre retrospective cohort study [2008-2023] of pts who commenced RCHOP/RDHAC for MCL. Descriptive statistics, Kaplan-Meier survival analysis, impact of baseline variables tested, and nephrotoxicity graded by CTCAE v5.

Results

Of 36 pts identified, 34 completed intended therapy. Median age was 63 yrs (range 37-76), 32 males (89%), stage 4=28 (78%), MIPI low 33%/int 47%/high 19%, aggressive morphology=19%, p53=90% (9/10) and high Ki67=63% (15/24). Mean induction relative dose intensity was 99% (SD 5%). Autograft was performed in 26 pts; insufficient stem cell collection in 1 patient. Response was evaluable by PET/CT prior to autograft in 31 pts; not assessed in 5 pts: 25 complete response, 5 partial response and 1 progressive disease (ORR 97%). By Jun 2023, with median (m) follow-up of 85 mo: 16 pts died, 12 relapsed; mPFS 90 mo and mOS 112 mo; mOS following relapse/progression 16 mo despite bruton tyrosine kinase inhibitor use in 7 pts (54%). Nephrotoxicity with induction was uncommon (Table); 1 pt required dialysis in setting of organ failure associated with sepsis. Median admission duration per pt for induction therapy was 5 days (IQR, 0-9.5). Table: 345P

Table: 345P Adverse events

ˆincludes 1 pt with sepsis during stem cell mobilization with RDHAC; 1 pt with acute on chronic renal impairment with RCHOP*includes 1 pt with sepsis during stem cell mobilization with RDHAC

Conclusions

This retrospective analysis is one of the largest cohorts of RCHOP/RDHAC reported in MCL. Low rates of clinically relevant nephrotoxicity with comparable long-term outcomes highlight carboplatin substitution as an option in selected pts. Survival after relapse remains poor.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.