Behind the TRIANGLE Study in MCL With Dr. Dreyling

Martin Dreyling, MD, University Hospital LMU Munich, in Germany, discusses the final follow-up results of the TRIANGLE study (NCT02858258), which evaluated whether standard treatment with autologous stem-cell transplantation (ASCT) was superior to a treatment adding ibrutinib (Imbruvica), but without ASCT, in patients with mantle cell lymphoma.

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0:10 | The TRIANGLE study is an international study investigating the optimal treatment in younger patients with mantle cell lymphoma. What has been known before is that, in these younger patients, first-line treatment is based on cytarabine-containing induction, a dose intensification by autologous stem cell transplant, and finally, by rituximab maintenance. We compared this standard arm by exploring 2 experimental arms, including ibrutinib, which is a BTKi, which is the most efficient salvage treatment in relapsed mantle cell lymphoma.

0:54 | Well, what about the final results after a final follow-up of more than 5 years? Well, what we can see so far, in fact, is, first of all, the progression-free survival was improved in both experimental arms, and that is not only statistically significant, but clinically meaningful, with an improvement in the range of 10% in comparison to the standard arm. The same holds up for overall survival, and based on these data, it is safe to say that the ibrutinib-containing regimen is now the new standard-of-care in younger patients with mantle cell lymphoma.

1:34 | Now, every answer opens new questions, and now the question was, does rituximab maintenance still improve outcomes in these patients? And yet, that is the case in both ibrutinib arms. So, if we are talking maintenance, we are talking about a combined rituximab and ibrutinib maintenance. Secondly, if we take ibrutinib for granted, do we still need autologous stem cell transplant, whereas this is not the case for the overall group. What we could identify is that about 10% of very high-risk patients still benefit from the addition of autologous stem cell transplant. Having said that, you still have to keep in mind you also increase therapy related toxicity. Therefore, this addition of autologous transplant in the ultra high-risk patients still remains an individual decision.