Older or unfit patients with mantle cell lymphoma (MCL) often do not tolerate intensive first-line therapies due to poor tolerability.¹ In such cases, bendamustine-rituximab (BR) combination is the most commonly used first-line regimen.¹ While adding Bruton's tyrosine kinase inhibitors (BTKi), such as ibrutinib, to BR has demonstrated improved progression-free survival (PFS), this approach has not translated into an overall survival (OS) benefit, primarily due to toxicity.¹

Acalabrutinib, a next-generation BTKi with fewer off-target effects, was introduced to address this limitation.¹ The ECHO trial evaluated the efficacy and safety of acalabrutinib + BR (ABR) in older patients with previously untreated MCL.¹ In the primary analysis, ABR was shown to significantly improve PFS compared to placebo + BR (PBR) in older patients with previously untreated MCL, with a trend favoring acalabrutinib in OS.¹

The ECHO trial was a phase 3, randomized, multicenter, double-blind, placebo-controlled study enrolling patients aged 65 years or older with previously untreated MCL.¹ Patients with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 were included and stratified by the simplified international prognostic index (sMIPI) score and geographic regions.¹ Participants were randomized 1:1 to receive either ABR (n=299) or PBR (n=299).¹ The median age across both arms was 71 years; most patients were male.¹ The updated analysis presented additional efficacy (PFS among subgroups and MRD data) and safety results (including exposure-adjusted incidence rates and timing of adverse events [AEs]).¹

Mantle cell lymphoma (MCL) is a B cell malignancy that is typically clinically aggressive with a poor prognosis.¹ When MCL patients progress into relapsed/refractory MCL (RRMCL), the median overall survival (OS) is usually reduced to around 1 year. Currently, three Bruton’s tyrosine kinase inhibitor

Mantle cell lymphoma (MCL) is an uncommon but aggressive subtype of lymphoid malignancy, generally considered to have a poor prognosis.¹ Although the disease responds well to initial treatment, relapse will inevitably occur,¹