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: Riikka Räty, Tuomo Honkanen, Esa Jantunen, Sirkku Jyrkkiö, Marja-Liisa Karjalainen-Lindsberg, Outi Kuittinen, Minna Lehto, Maija Mikkola, Eira Poikonen, Auvo Rauhala, Johanna Rimpiläinen, Anu Räsänen, Sanna Siitonen, Merja Suominen, Mirja Vapaatalo, Erkki Elonen
• Journal: Leukemia & lymphoma (Leuk Lymphoma) Vol. 53 Issue 10 Pg. 1920-8 (Oct 2012) ISSN: 1029-2403 [Electronic] United States
• PMID: 22397313 (Publication Type: Clinical Trial, Phase II, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal, Murine-Derived
• R-CHOP protocol
• Cytarabine
• Rituximab
• Vincristine
• Doxorubicin
• Cyclophosphamide
• Vidarabine
• fludarabine
• Prednisone

Topics

• Aged
• Aged, 80 and over
• Antibodies, Monoclonal, Murine-Derived (administration & dosage, adverse effects, therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Cyclophosphamide (adverse effects, therapeutic use)
• Cytarabine (administration & dosage)
• Doxorubicin (adverse effects, therapeutic use)
• Female
• Humans
• Induction Chemotherapy
• Lymphoma, Mantle-Cell (drug therapy, mortality)
• Maintenance Chemotherapy
• Male
• Prednisone (adverse effects, therapeutic use)
• Rituximab
• Treatment Outcome
• Vidarabine (administration & dosage, analogs & derivatives)
• Vincristine (adverse effects, therapeutic use)