title: Pre-emptive treatment with rituximab of molecular relapse after autologous stem cell transplantation in mantle cell lymphoma.
abstract: OBJECTIVE
  Minimal residual disease (MRD) is predictive of clinical progression in mantle-cell lymphoma (MCL). According to the Nordic MCL-2 protocol we prospectively analyzed the efficacy of pre-emptive treatment using rituximab to MCL patients in molecular relapse after autologous stem cell transplantation (ASCT).
  
  
  METHODS
  MCL patients enrolled onto the study, who had polymerase chain reaction (PCR) detectable molecular markers and underwent ASCT, were followed with serial PCR assessments of MRD in consecutive bone marrow and peripheral blood samples after ASCT. In case of molecular relapse with increasing MRD levels, patients were offered pre-emptive treatment with rituximab 375 mg/m(2) weekly for 4 weeks.
  
  
  RESULTS
  Of 160 MCL patients enrolled, 145 underwent ASCT, of whom 78 had a molecular marker. Of these, 74 were in complete remission (CR) and four had progressive disease after ASCT. Of the CR patients, 36 underwent a molecular relapse up to 6 years (mean, 18.5 months) after ASCT. Ten patients did not receive pre-emptive treatment mainly due to a simultaneous molecular and clinical relapse, while 26 patients underwent pre-emptive treatment leading to reinduction of molecular remission in 92%. Median molecular and clinical relapse-free survival after pre-emptive treatment were 1.5 and 3.7 years, respectively. Of the 38 patients who remain in molecular remission for now for a median of 3.3 years (range, 0.4 to 6.6 years), 33 are still in clinical CR.
  
  
  CONCLUSIONS
  Molecular relapse may occur many years after ASCT in MCL, and PCR based pre-emptive treatment using rituximab is feasible, reinduce molecular remission, and may prevent clinical relapse.
authors: Department of Hematology L-4041, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark. ns_andersen@msn.com
authors: Niels S
authors: NS
authors: Andersen
authors: Lone B
authors: LB
authors: Pedersen
authors: Anna
authors: A
authors: Laurell
authors: Erkki
authors: E
authors: Elonen
authors: Arne
authors: A
authors: Kolstad
authors: Anne Marie
authors: AM
authors: Boesen
authors: Lars M
authors: LM
authors: Pedersen
authors: Grete F
authors: GF
authors: Lauritzsen
authors: Roald
authors: R
authors: Ekanger
authors: Herman
authors: H
authors: Nilsson-Ehle
authors: Marie
authors: M
authors: Nordström
authors: Susanne
authors: S
authors: Fredén
authors: Mats
authors: M
authors: Jerkeman
authors: Mikael
authors: M
authors: Eriksson
authors: Jaan
authors: J
authors: Väärt
authors: Beatrice
authors: B
authors: Malmer
authors: Christian H
authors: CH
authors: Geisler
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005240:Feasibility Studies; D015321:Gene Rearrangement; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics; D020522:Lymphoma, Mantle-Cell / Q000188:drug therapy* / Q000235:genetics / Q000628:therapy; D018365:Neoplasm, Residual / Q000188:drug therapy* / Q000235:genetics; D016133:Polymerase Chain Reaction; D012008:Recurrence; D000069283:Rituximab; D033581:Stem Cell Transplantation / Q000379:methods*; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D007143:Immunoglobulin Heavy Chains; D000069283:Rituximab