尽管化疗免疫治疗是曼特尔细胞淋巴瘤（MCL）初始治疗的标准，但新的数据表明，无化疗的方法可能有一定作用。我们报告了一项多中心2期研究关于来那度胺联合利妥昔单抗（LR）作为MCL初始治疗的9年随访结果。LR双联疗法用作诱导和维持治疗，直至疾病进展，3年后可选择停药。我们先前报告了可评估患者中的总体缓解率为92％，其中64％达到完全缓解。在中位随访时间为103个月的情况下，36名可评估患者中有17人（47％）仍处于缓解状态。9年无进展生存率（PFS）和总生存率（OS）分别为51％和66％。在维持期间，造血系统不良事件（AEs）包括无症状的3级或4级细胞减少症（42％的中性粒细胞减少症，5％的血小板减少症，3％的贫血症）以及主要为1级至2级感染，可在门诊进行管理（50％上呼吸道感染，21％尿路感染，16％鼻窦炎，16％蜂窝织炎，13％肺炎，其中5％需要住院）。维持治疗期间，较多患者出现1级和2级神经病变（29％），而诱导治疗期间的比例为8％。21％的患者发生了继发性恶性肿瘤，其中5％为侵袭性恶性肿瘤，其余为非侵袭性皮肤癌，采用局部皮肤定向治疗。由于对COVID-19大流行期间免疫抑制的担忧，两名患者永久停止了治疗。随着长期随访，LR作为初始诱导治疗继续显示出持久的缓解反应，并且具有可控的安全性。版权所有 © 2023 美国血液学会。

While chemoimmunotherapy is the current standard of care for initial treatment of mantle cell lymphoma (MCL), newer data suggests that there may be a role for a chemotherapy-free approach. We report 9-year follow up of a multi-center phase 2 study of lenalidomide plus rituximab (LR) as initial treatment of MCL. The LR doublet is used as induction and maintenance until progression, with optional discontinuation after 3 years. We previously reported an overall response rate in evaluable patients of 92%, with 64% achieving a complete response. At a median follow up of 103 months, 17 (47%) of 36 evaluable patients remain in remission. The 9-year progression-free survival (PFS) and overall survival (OS) were 51% and 66%, respectively. During maintenance, hematologic adverse events (AEs) included asymptomatic grade 3 or 4 cytopenia (42% neutropenia, 5% thrombocytopenia, 3% anemia) and mostly grade 1 to 2 infections managed in the outpatient setting (50% upper respiratory infections, 21% urinary tract infections, 16% sinusitis, 16% cellulitis, 13% pneumonia, with 5% requiring hospitalization). More patients developed grade 1 and 2 neuropathy during maintenance therapy (29%) than during induction therapy (8%). Twenty-one percent of patients developed secondary malignancies including 5% with invasive malignancies, while the remainder were non-invasive skin cancers treated with local skin-directed therapy. Two patients permanently discontinued therapy due to concerns for immunosuppression during the COVID-19 pandemic. With long-term follow up, LR continues to demonstrate prolonged, durable responses with manageable safety as initial induction therapy.Copyright © 2023 American Society of Hematology.