Obinutuzumab and venetoclax induced complete remission in a patient with ibrutinib‐resistant non‐nodal leukemic mantle cell lymphoma

• Published in: European journal of haematology Vol. 104; no. 4; pp. 352 - 355
• Main Authors: Zhou, Xiang, Steinhardt, Maximilian Johannes, Düll, Johannes, Krummenast, Franziska, Danhof, Sophia, Meckel, Katharina, Nickel, Katharina, Grathwohl, Denise, Leicht, Hans‐Benno, Rosenwald, Andreas, Einsele, Hermann, Rasche, Leo, Kortüm, Martin
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-04-2020
• Subjects: Aged; Antibodies, Monoclonal, Humanized - therapeutic use; Antineoplastic Agents, Immunological - therapeutic use; Bridged Bicyclo Compounds, Heterocyclic - therapeutic use; Disease-Free Survival; Dose-Response Relationship, Drug; Drug Resistance, Neoplasm; Humans; Immunotherapy; Leukemia; Lymphoma, Mantle-Cell - drug therapy; Male; Mantle cell lymphoma; Monoclonal antibodies; obinutuzumab; Pyrazoles - therapeutic use; Pyrimidines - therapeutic use; Remission; Remission Induction; Rituximab; Salvage Therapy; Sulfonamides - therapeutic use; Targeted cancer therapy; venetoclax; venetoclax; mantle cell lymphoma; obinutuzumab
• ISSN: 0902-4441; 1600-0609
• DOI: 10.1111/ejh.13382

We herein report the case of a 73‐year‐old male patient who was diagnosed with leukemic non‐nodal MCL. This patient had received six cycles of bendamustine, which resulted in a transient remission, and a second‐line therapy with ibrutinib, which unfortunately failed to induce remission. We started a treatment with single‐agent obinutuzumab at a dose of 20 mg on day 1, 50 mg on day 2‐4, 330 mg on day 5, and 1000 mg on day 6. The laboratory analysis showed a rapid decrease of leukocyte count. Four weeks later, we repeated the treatment with obinutuzumab at a dose of 1000 mg q4w and started a therapy with venetoclax at a dose of 400 mg qd, which could be increased to 800 mg qd from the third cycle. This combination therapy was well tolerated. The patient achieved a complete remission (CR) after three cycles of obinutuzumab and venetoclax. To date, the patient has a progression‐free survival of 17 months under ongoing obinutuzumab maintenance q4w. This is the first report about obinutuzumab and venetoclax induced CR in rituximab‐intolerant patient with an ibrutinib‐resistant MCL. This case suggests that obinutuzumab‐ and venetoclax‐based combination therapy might be salvage therapy in patients with ibrutinib‐resistant MCL.