title: Comparative outcome of initial therapy for younger patients with mantle cell lymphoma: an analysis from the NCCN NHL Database.
abstract: Few randomized trials have compared therapies in mantle cell lymphoma (MCL), and the role of aggressive induction is unclear. The National Comprehensive Cancer Network (NCCN) Non-Hodgkin Lymphoma (NHL) Database, a prospective cohort study collecting clinical, treatment, and outcome data at 7 NCCN centers, provides a unique opportunity to compare the effectiveness of initial therapies in MCL. Patients younger than 65 diagnosed between 2000 and 2008 were included if they received RHCVAD (rituximab fractionated cyclophosphamide, vincristine, adriamycin, and dexamethasone), RCHOP+HDT/ASCR (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone + high-dose therapy/autologous stem cell rescue), RHCVAD+HDT/ASCR, or RCHOP. Clinical parameters were similar for patients treated with RHCVAD (n = 83, 50%), RCHOP+HDT/ASCR (n = 34, 20%), RCHOP (n = 29, 17%), or RHCVAD+HDT/ASCR (n = 21, 13%). Overall, 70 (42%) of the 167 patients progressed and 25 (15%) expired with a median follow-up of 33 months. There was no difference in progression-free survival (PFS) between aggressive regimens (P > .57), which all demonstrated superior PFS compared with RCHOP (P < .004). There was no difference in overall survival (OS) between the RHCVAD and RCHOP+HDT/ASCR (P = .98). RCHOP was inferior to RHCVAD and RCHOP+HDT/ASCR, which had similar PFS and OS. Despite aggressive regimens, the median PFS was 3 to 4 years. Future trials should focus on novel agents rather than comparing current approaches.
authors.affiliation: Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02115, USA. ann_lacasce@dfci.harvard.edu
authors.forename: Ann S
authors.initials: AS
authors.lastname: LaCasce
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Vandergrift
authors.forename: Maria A
authors.initials: MA
authors.lastname: Rodriguez
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Abel
authors.forename: Allison L
authors.initials: AL
authors.lastname: Crosby
authors.forename: Myron S
authors.initials: MS
authors.lastname: Czuczman
authors.forename: Auayporn P
authors.initials: AP
authors.lastname: Nademanee
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Blayney
authors.forename: Leo I
authors.initials: LI
authors.lastname: Gordon
authors.forename: Michael
authors.initials: M
authors.lastname: Millenson
authors.forename: Ann
authors.initials: A
authors.lastname: Vanderplas
authors.forename: Eva M
authors.initials: EM
authors.lastname: Lepisto
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Zelenetz
authors.forename: Joyce
authors.initials: J
authors.lastname: Niland
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Friedberg
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D006801:Humans; D020522:Lymphoma, Mantle-Cell / Q000188:drug therapy* / Q000401:mortality; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome