title: Oral arsenic trioxide-based regimen as salvage treatment for relapsed or refractory mantle cell lymphoma.
abstract: BACKGROUND
  Mantle cell lymphoma (MCL) is aggressive, and relapsed/refractory disease has poor outcomes.
  
  
  METHODS
  Thirty-nine patients (men = 34, women = 5) at 64 (41-82) years of age with relapsed/refractory MCL, ineligible for high-dose chemotherapy and had received 2 (1-5) prior regimens, were treated with a continuous oral regimen, comprising oral arsenic trioxide (oral-As2O3), chlorambucil and ascorbic acid.
  
  
  RESULTS
  Overall response rate was 49% (complete response, CR = 28%; partial response, PR = 21%). Only grade 1/2 toxicities were observed (hematologic: 56%, hepatic: 8%). Response was maintained in 11 patients (CR = 8; PR = 3), after a median of 24 (2-108) months. Independent prognostic factors for response were increased lactate dehydrogenase (P = 0.04) and unfavorable MCL international prognostic index (P = 0.04). At a median follow-up of 21 (1-118) months, the median progression-free survival (PFS) was 16 months, and overall survival (OS) 38 months. Independent prognostic factors for PFS were female gender (P = 0.002), and Eastern Cooperative Oncology Group (ECOG) performance score of 2 (P = 0.009). Independent prognostic factors for OS were female gender (P < 0.001), ECOG performance score of 2 (P = 0.03), non-response (P < 0.001), and disease progression after initial response (P = 0.05).
  
  
  CONCLUSIONS
  An oral regimen of oral-As2O3, chlorambucil and ascorbic acid was active with minimal toxicity in relapsed/refractory MCL, achieving durable responses in ∼30% of cases.
authors.affiliation: Department of Medicine, Queen Mary Hospital, Hong Kong.
authors.forename: H
authors.initials: H
authors.lastname: Gill
authors.affiliation: Blood-Med Clinic, Crawford House, Hong Kong.
authors.forename: W Y
authors.initials: WY
authors.lastname: Au
authors.affiliation: Department of Medicine, Queen Mary Hospital, Hong Kong.
authors.forename: W W
authors.initials: WW
authors.lastname: Cheung
authors.affiliation: Department of Diagnostic Radiology, Queen Mary Hospital, Hong Kong, China.
authors.forename: E Y
authors.initials: EY
authors.lastname: Lee
authors.affiliation: Department of Medicine, Queen Mary Hospital, Hong Kong. Electronic address: ylkwong@hkucc.hku.hk.
authors.forename: Y L
authors.initials: YL
authors.lastname: Kwong
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D020522:Lymphoma, Mantle-Cell / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008875:Middle Aged; D010087:Oxides / Q000008:administration & dosage / Q000627:therapeutic use*; D049268:Positron-Emission Tomography; D012008:Recurrence; D016879:Salvage Therapy; D016019:Survival Analysis
chemical_list: D001152:Arsenicals; D010087:Oxides; D000077237:Arsenic Trioxide
keywords: mantle cell lymphoma; oral arsenic trioxide; refractory; relapsed