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SAN DIEGO -- The scientific program of the American Society of Hematology (ASH) annual meeting included thousands of posters presented over a 3-day period. A selected few on some more rare types of lymphoma are summarized below.

BTK Inhibition Safe in Upfront MCL

Treatment with the Bruton tyrosine kinase (BTK) inhibitor acalabrutinib (Calquence) in combination with first-line chemoimmunotherapy was safe in patients with mantle cell lymphoma (MCL), according to phase Ib data presented here.

In the study of 38 patients, acalabrutinib plus bendamustine and rituximab (Rituxan) yielded complete response (CR) rates of 72% in untreated MCL patients and 65% in a cohort with relapsed or refractory disease, reported Tycel Phillips, MD, of the University of Michigan Cancer Center.

The overall response rate was 94% in the untreated group and 85% in the relapsed or refractory group. Median progression-free survival had not been reached in either group after a median of 21 and 17 months follow-up, respectively.

In 2017, acalabrutinib received FDA approval for MCL in the second-line setting, following data from a trial of 124 patients that reported an overall response rate of 81% and CR rate of 40%.

Common (≥20%) adverse events (AEs) of any grade among all patients in the current study included nausea, fatigue, neutropenia, diarrhea, vomiting, cough, upper respiratory tract infection, constipation, headache, dizziness, infusion‐related reactions, and pyrexia.

For the two groups combined, grade ≥3 AEs that occurred in at least two patients included neutropenia (45%), decreased neutrophil count (11%), pneumonia (11%), and thrombocytopenia (8%); abdominal pain, acute kidney injury, anemia, decreased white blood cell count, diarrhea, hypertension, hyperuricemia, hypotension, and leukopenia each occurred in 5% of patients.

Phillips' group said that the high response rates in both arms "further support an ongoing phase III randomized, double‐blind, placebo‐controlled study" testing the three-drug combination in the first-line setting against bendamustine and rituximab alone.

Toxicity High With Lenalidomide/CHOEP in Frontline PTCL

Adding lenalidomide (Revlimid) to CHOEP (cyclophosphamide, doxorubicin, vincristine, and prednisone [CHOP] plus etoposide) in previously untreated peripheral T-cell lymphoma (PTCL) led to high rates of discontinuation but only modest rates of CR, a phase II study found.

In 39 evaluable patients with different PTCL subtypes, the rates of overall response and CR were 69% and 49%, respectively, reported Matthew Lunning, DO, of the University of Nebraska Medical Center in Omaha.

But seven patients had to discontinue treatment due to toxicity. Hematologic grade 3/4 AEs were common: neutropenia (68%), leukopenia (63%), anemia (43%), thrombocytopenia (43%), lymphopenia (45%), and febrile neutropenia (38%). Non-hematologic grade 3/4 AEs were rare, with diarrhea (8%) and peripheral sensory neuropathy (5%) being the most frequently occurring.

In all, 27 patients completed the treatment course of six cycles of 10-mg lenalidomide during days 1-10 of CHOEP (CR rate of 63% in these patients), and 16 patients in the study went on to receive autologous stem cell transplantation. Lunning's group will continue to assess patients for progression-free and overall survival.

Half the patients had PTCL not otherwise specified, 15 had the angioimmunoblastic T-cell lymphoma subtype, and 4 had anaplastic large-cell lymphoma that was anaplastic lymphoma kinase (ALK)-negative. All patients were stage II-IV, most had International Prognostic Index (IPI) low-intermediate risk (41%) or high-intermediate risk (33%) disease, and there was splenic involvement in 39%.

Skipping Radiation OK in Primary Mediastinal B-Cell Lymphoma

Most primary mediastinal B-cell lymphoma (PMBL) patients in metabolic CR on an end-of-treatment PET scan did fine without consolidation radiotherapy (RT), according to retrospective data from a single center study.

Among 22 patients who achieved a CR following rituximab plus CHOP (R-CHOP), only 9% experienced a relapse at a median 5 years follow-up, according to Vasiliki Michalarea, MD, of Royal Marsden NHS Foundation Trust in London.

Yet only two of these patients had received consolidation RT (both remained in remission).

"The majority of patients with a negative end-of-treatment PET scan following R-CHOP chemotherapy may not need consolidation radiotherapy," Michalarea's group concluded. "This finding should be taken into account when considering the risk/benefit of adding radiotherapy treatment to patients who are already in metabolic CR after chemotherapy."

For their study, the researchers reviewed Royal Marsden records from 2003 to 2015 for patients diagnosed and treated for PMBL, a high-grade type of non-Hodgkin's lymphoma with no established best chemotherapy regimen. While some centers favor more intensive regimens, most patients (94%) in this series received R-CHOP, they said.

In all the study included 34 patients, and end-of-treatment PET scans were available for 29 of them. Patients by and large (91%) had good performance status (ECOG 0-1), 76% had an IPI score of 0-1, and 76% were Ann Arbor Stage I-II. B symptoms were present in 74% of patients, and most (91%) did not have bone marrow involvement. In terms of disease bulk, 74% of patients had masses ≥10 cm.