Intensive chemotherapy and consolidation with high dose therapy and autologous stem cell transplant in patients with mantle cell lymphoma.
Mantle cell lymphoma (MCL) remains incurable with conventional chemotherapy without consensus on the optimal initial treatment. We examined our single center experience with frontline therapy for patients with MCL in consecutive cases diagnosed 1995-2011. Among 81 patients, median age was 59 (28% were ≥65 years of age), 95% had stage III/IV disease and 54% had a low risk MCL International Prognostic Index score. Thirty-five percent (n=28) received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and 65% received R-HCVAD (rituximab, hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone alternating with high-dose methotrexate/cytarabine; n=53). Forty-one patients were consolidated with autologous stem cell transplant (ASCT). There were no significant differences in 2-year survival for R-CHOP versus R-HCVAD (p=0.10) or for ASCT versus observation (p=0.06). After controlling for clinical factors, R-HCVAD followed by ASCT was associated with superior progression-free survival (hazard ratio 0.26, 95% confidence interval 0.09-0.75).
Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine , Atlanta, GA , USA.
Loretta J
LJ
Nastoupil
Pareen J
PJ
Shenoy
Alex
A
Ambinder
Jean L
JL
Koff
Ajay K
AK
Nooka
Edmund K
EK
Waller
Amelia
A
Langston
Miray
M
Seward
Jonathan L
JL
Kaufman
Leon
L
Bernal-Mizrachi
Nassoma
N
King
Mary Jo
MJ
Lechowicz
Sagar
S
Lonial
Rajni
R
Sinha
Christopher R
CR
Flowers
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D020522:Lymphoma, Mantle-Cell / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D033581:Stem Cell Transplantation / Q000379:methods*; D014182:Transplantation, Autologous
Mantle cell lymphoma; R-CHOP regimen; R-HCVAD regimen; autologous transplant; outcomes