Ibrutinib for mantle cell lymphoma at first relapse: a United Kingdom real-world analysis of outcomes in 211 patients

Ibrutinib is an established treatment for relapsed/refractory (R/R) mantle cell lymphoma (MCL) and clinical trial data supports use at second line compared to later relapse. We aimed to investigate outcomes and tolerability for ibrutinib when given second line in a real-world setting. Our multicentre retrospective analysis included 211 R/R MCL patients, median age 73 years, receiving ibrutinib second-line within the United Kingdom's National Health Service. Overall response to ibrutinib was 69% (complete response 27%). The median progression-free survival (PFS) was 17 center dot 8 months (95% CI 13 center dot 1-22 center dot 2) and median overall survival (OS) 23 center dot 9 months (95% CI 15 center dot 0-32 center dot 8). Drug-related adverse event led to dose reduction in 10% of patients and discontinuation in 5%. In patients with progressive disease, accounting for 100 of 152 patients stopping ibrutinib, 43% received further systemic therapy. Post-ibrutinib rituximab, bendamustine and cytarabine (R-BAC) showed a trend toward improved survival compared to alternative systemic treatments (post-ibrutinib median OS 14 center dot 0 months, 95% CI 8 center dot 1-19 center dot 8, vs. 3 center dot 6 months, 95% CI 2 center dot 6-4 center dot 5, P = 0 center dot 06). Our study confirms the clinical benefit and good tolerability of ibrutinib at first relapse in a real-world population. Patients progressing on ibrutinib had limited survival but outcomes with R-BAC in select patients were promising.

Automated summary

This study demonstrates the good tolerability and clinical benefit of ibrutinib as a second-line therapy for R/R MCL patients. Patients who progressed on ibrutinib had limited survival, but the use of R-BAC in select patients showed promising outcomes.