Open AccessClinical outcomes for ibrutinib in relapsed or refractory mantle cell lymphoma in real‐world experience
Author(s) -
Jeon YoungWoo,
Yoon Seugyun,
Min Gi June,
Park SungSoo,
Park Silvia,
Yoon JaeHo,
Lee SungEun,
Cho ByungSik,
Eom KiSeong,
Kim YooJin,
Kim HeeJe,
Lee Seok,
Min ChangKi,
Lee Jong Wook,
Cho SeokGoo
Publication year - 2019
Publication title -
cancer medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 53
ISSN - 2045-7634
DOI - 10.1002/cam4.2565
Subject(s) - ibrutinib , medicine , mantle cell lymphoma , bendamustine , oncology , salvage therapy , refractory (planetary science) , international prognostic index , lymphoma , chemotherapy , rituximab , leukemia , chronic lymphocytic leukemia , physics , astrobiology
Ibrutinib is highly effective in patients with relapsed or refractory mantle cell lymphoma (MCL) in major clinical trials. Although there has been a dramatic improvement in survival outcomes in the salvage setting, nonresponders to ibrutinib have a bleak prognosis. Therefore, this retrospective study was conducted to identify the most appropriate therapeutic strategy and prognosis‐related factors to predict the response of patients with relapsed or refractory MCL to ibrutinib monotherapy. Thirty‐three consecutive refractory or relapsed MCL patients treated with ibrutinib were analyzed in this study. The median overall survival (OS) and progression‐free survival (PFS) after initiation of ibrutinib were 35.1 months and 27.4 months, respectively. Risk factor analysis showed that high risk according to the Mantle Cell Lymphoma International Prognostic Index (MIPI) and nonresponse to ibrutinib at the first three cycles were significantly associated with inferior OS. Poor PFS was associated with high‐risk biologic MIPI, prior bendamustine exposure, and nonresponse to ibrutinib during the first three cycles. After ibrutinib failure, primary nonresponders had poorer OS and PFS than inconsistent responders. The overall response rate for the first salvage therapy was only 33%, with a median TTP of 3.2 months. There was no effective therapeutic strategy except for allogeneic hematopoietic stem cell transplantation (allo‐HSCT). Although ibrutinib responders exhibited favorable survival outcomes, nonresponders had a dismal prognosis. To overcome these limitations, it may be necessary to modify therapeutic strategies, such as selecting inconsistent responders for earlier allo‐HSCT.