Dr. McCulloch on the Use of R-BAC in MCL After Progression on BTK Therapy

Rory McCulloch, MD, vice chair, South West Peninsula, HaemSTAR, hematology registrar, University Hospitals, Plymouth, discusses the use of R-BAC (rituximab [Rituxan],bendamustine, and cytarabine) in patients with mantle cell lymphoma (MCL) who had progressed on initial therapy with a BTK inhibitor.

In a retrospective study, McCulloch and investigators examined the use of R-BAC in patients who had progressed on initial therapy with a BTK inhibitor. Although R-BAC is recommended for use in patients with MCL, it is not a suitable regimen for everyone, as it does carry a high rate of hematologic toxicity. This can, however, be offset to a certain extent by attenuating the doses.

The oldest patient enrolled in the trial was 79-years-old. The patient had a short response to ibrutinib (Imbruvica) and was subsequently given 1 dose of bendamustine and cytarabine. He tolerated the regimen fairly well and went on to have a response that lasted over 2 years, says McCulloch. This serves as proof that the regimen should not be restricted on the basis of age. Rather, the prognosis of the patient and their fitness should be weighed against the potential toxicities and dosing schedules of the regimen.