More is not always better

In this issue of Blood, , Smith et al show that bendamustine-rituximab (BR) followed by rituximab maintenance (R) represents an effective induction regimen for patients with mantle cell lymphoma (MCL).1 1 The authors conclude that this combination is viable standard initial therapy, at least for older patients, and can be considered the preferable comparator for developing newer regimens. The present trial had 2 coprimary objectives and 4 arms, aiming at improving progression-free survival (PFS) either with the addition of bortezomib to BR induction or lenalidomide to R maintenance. All 3 experimental arms failed to demonstrate a PFS advantage compared with the backbone BR + R (see fi gure). Furthermore, bortezomib was reported to increase the risk of neutropenia and sensory neuropathy during induction, and lenalidomide was associated with higher rates of neutropenia, rash, fatigue, and discontinuation of therapy due to adverse events prior to the completion of the planned 24 cycles.