| Autor: |
Carras S; Univ. Grenoble Alpes. University Hospital, Grenoble France, Institute For Advanced Biosciences (INSERM U1209, CNRS UMR 5309, UGA), Molecular biology department; Univ. Grenoble Alpes. University Hospital, Grenoble France, Institute For Advanced Biosciences (INSERM U1209, CNRS UMR 5309, UGA), Oncohematology department., Torroja A; Univ. Grenoble Alpes. University Hospital, Grenoble France, Institute For Advanced Biosciences (INSERM U1209, CNRS UMR 5309, UGA), Oncohematology department., Emadali A; Univ. Grenoble Alpes. University Hospital, Grenoble France, Institute For Advanced Biosciences (INSERM U1209, CNRS UMR 5309, UGA), Research and innovation unit., Montaut E; Univ. Grenoble Alpes. University Hospital, Grenoble France, Institute For Advanced Biosciences (INSERM U1209, CNRS UMR 5309, UGA), Research and innovation unit., Daguindau N; Hematology Department Annecy hospital., Tempescul A; Hematology Unit, Brest University Hospital, Brest France., Moreau A; Pathology Department, University Hospital, Nantes., Tchernonog E; Hematology Department, University Hospital, Montpellier., Schmitt A; Hematology Department, Cancerology Institute Bergonie, Bordeaux., Houot R; Hematology Department, University Hospital, Rennes., Dartigeas C; Hematology Department, University Hospital, Tours., Barbieux S; Hematology Department, Dunkerque Hospital., Corm S; Hematology Department, Chambery., Banos A; Hematology Department, Bayonne Cote Basque Hospital., Fouillet L; Hematology Department, University Hospital, Saint Etienne., Dupuis J; Lymphoid malignancies Unit, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil., Macro M; IHBN - Hematology Department, University Hospital, Caen., Fleury J; Hematology Department, Cancerology Institute, Clermont-Ferrand., Jardin F; Hematology Department, Centre Henri Becquerel, Rouen., Sarkozy C; Institut Curie, Paris and Paris Saint Quentin University, UVSQ., Damaj G; Hematology Department, University Hospital, Caen., Feugier P; Hematology Department, University Hospital, Nancy., Fornecker LM; Hematology Department, University Hospital, Strasbourg., Chabrot C; Hematology Department, University Hospital, Clermont-Ferrand., Dorvaux V; Hematology Department, University Hospital, Metz., Bouabdallah K; Hematology Department, University Hospital, Bordeaux, Bordeaux., Amorim S; Hematology and cellular therapy Department, Hospital Saint Vincent de Paul, Université catholique de Lille., Garidi R; Hematology Department, Hospital Saint Quentin., Voillat L; Hematology Department, Hospital Chalon sur Saone., Joly B; Hematology Department, Corbeil Hospital., Morineau N; Hematology department, Hospital La Roche Sur Yon., Moles MP; Hematology Department, University Hospital Angers., Zerazhi H; Hematology Department, Avignon Hospital., Fontan J; Hematology Department, University Hospital, Besançon., Arkam Y; Hematology Department, Mulhouse Hospital., Alexis M; Hematology Department, Orleans Hospital., Delwail V; Onco-Hematology Department, University Hospital Poitiers and INSERM, CIC 1402, University of Poitiers., Vilque JP; Hematology Department, Cancer Center Baclesse Caen., Ysebaert L; Institut universitaire du cancer de Toulouse Oncopole., Burroni B; Assistance Publique - Hôpitaux de Paris (APHP), Hôpital Cochin, Department of Pathology; Centre de Recherche des Cordeliers, Sorbonne University, Inserm, UMRS 1138, Université Paris Cité, F-75006 Paris., Callanan M; Unit For Innovation in Genetics and Epigenetics and Oncology. Dijon University Hospital., Le Gouill S; Institut Curie, Paris and Paris Saint Quentin University, UVSQ., Gressin R; Univ. Grenoble Alpes. University Hospital, Grenoble France, Institute For Advanced Biosciences (INSERM U1209, CNRS UMR 5309, UGA), Oncohematology department. |
| Abstrakt: |
Between 2011 and 2012, a phase II trial evaluated the use of the RiBVD (rituximab, bendamustine, velcade and dexamethasone) combination as first-line treatment for mantle cell lymphoma (MCL) patients over the age of 65. We have now re-examined the classic prognostic factors, adding an assessment of TP53 mutation status. Patients (N=74; median age 73 years) were treated with the RiBVD combination. Median progression-free survival (mPFS) was 79 months and median overall survival (mOS) was 111 months. TP53 mutation status was available for 54/74 (73%) patients. TP53 mutations (TP53mt) were found in 12 patients (22.2%). In multivariate analysis, among the prognostic factors (PF) evaluated, only TP53mt and an albumin level (Alb) 3.6 g/dL were independently associated with a shorter mPFS. A hazard ratio (HR) of 3.16 (1.3-9.9, P=0.014) was obtained for TP53mt versus TP53 wild-type (wt), and 3.6 (1.39-9.5, P=0.009) for Alb <3.6 g/dL versus Alb ≥3.6 g/dL. In terms of mOS, multivariate analysis identified three PF: TP53mt (HR: 5.9 [1.77-19.5, P=0.004]), Alb <3.6 g/dL (HR: 5.2 [1.46- 18.5, P=0.011]), and ECOG=2 (HR: 3.7 [1.31-10.6, P=0.014]). Finally, a score combining TP53 status and Alb distinguished three populations based on the presence of 0, 1, or 2 PF. For these populations, mPFS was 7.8 years, 28 months, and 2.5 months, respectively. Our prolonged follow-up confirmed the efficacy of the RiBVD regimen, comparing it favorably to other regimens. TP53mt and hypoalbuminemia emerge as strong PF that can be easily integrated into prognostic scores for older adult patients with MCL. |
