title: VcR-CVAD induction chemotherapy followed by maintenance rituximab in mantle cell lymphoma: a Wisconsin Oncology Network study.
abstract: Intensive chemotherapy regimens are not feasible in many adults with mantle cell lymphoma (MCL). We sought to build upon our previous experience with a non-intensive regimen, modified R-hyperCVAD chemotherapy (rituximab, cyclophosphamide, vincristine, doxorubicin, dexamethasone) with maintenance rituximab (MR), by the incorporation of bortezomib (VcR-CVAD) and the extension of MR beyond 2 years. Patients with previously untreated MCL received VcR-CVAD chemotherapy every 21 d for six cycles. Patients achieving at least a partial response to induction chemotherapy received rituximab consolidation (375 mg/m(2) × 4 weekly doses) and MR (375 mg/m(2) every 12 weeks × 20 doses). The primary end points were overall and complete response (CR), and secondary endpoints were progression-free (PFS) and overall survival (OS). Thirty patients were enrolled, with a median age of 61 years. All patients had advanced stage disease, and 60% had medium/high MCL International Prognostic Index risk factors. A CR or unconfirmed CR was achieved in 77% of patients. After a median follow-up of 42 months, the 3-year PFS and OS were 63% and 86%, respectively. The observed 3-year PFS and OS with VcR-CVAD in MCL were comparable to reported outcomes with more intensive regimens. A cooperative group trial (E1405) is attempting to replicate these promising results.
authors.affiliation: Department of Medicine, School of Medicine and Public Health, The UW Carbone Cancer Center, University of Wisconsin, Madison, WI 53705, USA.
authors.forename: Julie E
authors.initials: JE
authors.lastname: Chang
authors.forename: Christopher
authors.initials: C
authors.lastname: Peterson
authors.forename: Sangbum
authors.initials: S
authors.lastname: Choi
authors.forename: Jens C
authors.initials: JC
authors.lastname: Eickhoff
authors.forename: KyungMann
authors.initials: K
authors.lastname: Kim
authors.forename: David T
authors.initials: DT
authors.lastname: Yang
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Gilbert
authors.forename: Eric S
authors.initials: ES
authors.lastname: Rogers
authors.forename: Jae E
authors.initials: JE
authors.lastname: Werndli
authors.forename: Michael S
authors.initials: MS
authors.lastname: Huie
authors.forename: Thomas A
authors.initials: TA
authors.lastname: McFarland
authors.forename: Michael
authors.initials: M
authors.lastname: Volk
authors.forename: Jules
authors.initials: J
authors.lastname: Blank
authors.forename: Natalie S
authors.initials: NS
authors.lastname: Callander
authors.forename: Walter L
authors.initials: WL
authors.lastname: Longo
authors.forename: Brad S
authors.initials: BS
authors.lastname: Kahl
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001897:Boronic Acids / Q000008:administration & dosage / Q000009:adverse effects; D000069286:Bortezomib; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006402:Hematologic Diseases / Q000139:chemically induced; D006801:Humans; D053208:Kaplan-Meier Estimate; D020522:Lymphoma, Mantle-Cell / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced; D016016:Proportional Hazards Models; D011480:Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D011719:Pyrazines / Q000008:administration & dosage / Q000009:adverse effects; D012074:Remission Induction; D000069283:Rituximab; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D001897:Boronic Acids; D011480:Protease Inhibitors; D011719:Pyrazines; D016179:Granulocyte Colony-Stimulating Factor; D000069283:Rituximab; D014750:Vincristine; D000069286:Bortezomib; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide