Sequential high-dose therapy and autologous stem cell transplantation for treatment of mantle cell lymphoma.

Abstract

BACKGROUND:

Mantle cell lymphoma (MC) is not curable with conventional chemotherapy. To improve the prognosis of patients with this disease, we prospectively studied an intensive sequential therapy consisting of the Dexa-BEAM regimen (dexamethasone, BCNU, etoposide, ara-C, melphalan) followed by myeloablative therapy with autologous stem cell reinfusion.

PATIENTS AND METHODS:

Nine consecutive patients with stage III/IV MC were included. Two had untreated disease, four were in first remission, whereas three had more advanced disease. All patients underwent one to two cycles of Dexa-BEAM chemotherapy to reduce the tumor load and to mobilize peripheral blood progenitor cells (PBPC). Subsequently, patients were treated with high-dose radiochemotherapy followed by PBPC reinfusion and were prospectively analyzed for residual disease by clinical methods as well as by PCR amplification clonal CDRIII rearrangements.

RESULTS:

With an overall response rate of 100%, the initial Dexa-BEAM cycles effectively reduced the tumor load. All patients proceeded to high-dose therapy and subsequent stem cell rescue. Engraftment was prompt, and procedure-related deaths did not occur. With a median follow-up of 12 (3-33) months post transplant, all patients are alive in continuing clinical and molecular remission.

CONCLUSIONS:

Sequential intensive therapy consisting of Dexa-BEAM and high-dose radiochemotherapy appears to be a highly effective treatment for patients with MC. However, the data are still preliminary, and larger patient numbers and a longer follow-up are required.

• Authors: P Dreger, N von Neuhoff, R Kuse, R Sonnen, B Glass, L Uharek, H Bartels, H Löffler, N Schmitz
• Journal: Annals of oncology : official journal of the European Society for Medical Oncology (Ann Oncol) Vol. 8 Issue 4 Pg. 401-3 (Apr 1997) ISSN: 0923-7534 [Print] England
• PMID: 9209672 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Cytarabine
• Etoposide
• Dexamethasone
• Melphalan
• Carmustine

Topics

• Adolescent
• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Carmustine (administration & dosage)
• Combined Modality Therapy
• Cytarabine (administration & dosage)
• Dexamethasone (administration & dosage)
• Dose-Response Relationship, Drug
• Etoposide
• Female
• Hematopoietic Stem Cell Transplantation
• Humans
• Immunophenotyping
• Lymphoma, Non-Hodgkin (pathology, therapy)
• Male
• Melphalan (administration & dosage)
• Middle Aged
• Neoplasm Staging
• Prospective Studies
• Transplantation, Autologous