title: Prolonged immunochemotherapy with rituximab, cytarabine and fludarabine added to cyclophosphamide, doxorubicin, vincristine and prednisolone and followed by rituximab maintenance in untreated elderly patients with mantle cell lymphoma: a prospective study by the Finnish Lymphoma Group.
abstract: There is no consensus on treatment strategies for elderly patients with mantle cell lymphoma (MCL). In this prospective phase II study we investigated whether the poor outcome could be improved, with reasonable toxicity, by prolonging the immunochemotherapy. Ten cycles of alternating cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP)/cytarabine (AraC) with eight doses of rituximab (R) were given as induction. The potential synergism of intermediate-dose AraC and fludarabine was tested in cycles 6-8. Induction was followed by bimonthly rituximab maintenance for 2 years. The median age of the 60 included patients was 74 years, and the Mantle Cell Lymphoma International Prognostic Index (MIPI) was intermediate or high risk in 98% of the patients. The overall response rate was 95% (complete response/complete response unconfirmed 87%). The response of 11 patients improved with cycles 6-8 (R-fludarabine-AraC). Progression-free survival was 70% and overall survival 72% at 4 years, respectively. Treatment related mortality was 2%. Severe infections were rare, with only one grade 4 infection. More dose reductions were needed during fludarabine-containing courses as compared to R-AraC. In 20 patients a transient grade 4 neutropenia without severe infections was recorded during maintenance. In conclusion, elderly patients with MCL can be treated relatively intensively with acceptable toxicity.
authors.affiliation: Department of Hematology, Helsinki University Central Hospital, Helsinki, Finland. riikka.raty@hus.fi
authors.forename: Riikka
authors.initials: R
authors.lastname: Räty
authors.forename: Tuomo
authors.initials: T
authors.lastname: Honkanen
authors.forename: Esa
authors.initials: E
authors.lastname: Jantunen
authors.forename: Sirkku
authors.initials: S
authors.lastname: Jyrkkiö
authors.forename: Marja-Liisa
authors.initials: ML
authors.lastname: Karjalainen-Lindsberg
authors.forename: Outi
authors.initials: O
authors.lastname: Kuittinen
authors.forename: Minna
authors.initials: M
authors.lastname: Lehto
authors.forename: Maija
authors.initials: M
authors.lastname: Mikkola
authors.forename: Eira
authors.initials: E
authors.lastname: Poikonen
authors.forename: Auvo
authors.initials: A
authors.lastname: Rauhala
authors.forename: Johanna
authors.initials: J
authors.lastname: Rimpiläinen
authors.forename: Anu
authors.initials: A
authors.lastname: Räsänen
authors.forename: Sanna
authors.initials: S
authors.lastname: Siitonen
authors.forename: Merja
authors.initials: M
authors.lastname: Suominen
authors.forename: Mirja
authors.initials: M
authors.lastname: Vapaatalo
authors.forename: Erkki
authors.initials: E
authors.lastname: Elonen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D003561:Cytarabine / Q000008:administration & dosage; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D020522:Lymphoma, Mantle-Cell / Q000188:drug therapy* / Q000401:mortality; D060046:Maintenance Chemotherapy; D008297:Male; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D000069283:Rituximab; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D003561:Cytarabine; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine; D011241:Prednisone