Abstract |
Mantle cell lymphoma (MCL) is rarely cured with standard-dose chemotherapy. From January 1997 to February 2000, 28 previously untreated advanced-stage MCL patients younger than 61 years of age were treated at 9 Italian hematologic departments with 3 cycles of standard-dose debulking chemotherapy followed by a high-dose rituximab-supplemented sequence (R-HDS) including intravenous administration of high-dose cyclophosphamide, high-dose cytarabine, high-dose melphalan, and high-dose mitoxantrone plus melphalan. Study end points included toxicity, clinical and molecular response rates, long-term event-free survival (EFS), and overall survival (OS) rates, as well as the ability to harvest tumor-free peripheral blood stem cells. Optimal amounts of polymerase chain reaction-negative (PCR-negative) CD34+ cells were collected from all 20 informative patients. One patient died of toxicity. All 27 patients assessable for response achieved a complete response (CR), of which 24 remain in continuous complete remission (CCR) after a median follow-up of 35 months. Three patients had transient evidence of PCR-detectable disease in the bone marrow. The OS and EFS rates at 54 months were 89% and 79%, respectively. These results compare with the 42% OS rate and the 18% EFS rate observed in 35 age-matched historic controls treated with standard-dose chemotherapy at the participating centers. The use of rituximab in combination with high-dose chemotherapy represents a very effective in vivo purging method. The R-HDS regimen can be safely applied in a multicenter hematology setting and leads to long-term EFS and OS in the majority of patients with an otherwise incurable disease.
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Authors | Alessandro M Gianni, Michele Magni, Maurizio Martelli, Massimo Di Nicola, Carmelo Carlo-Stella, Silvana Pilotti, Alessandro Rambaldi, Sergio Cortelazzo, Caterina Patti, Guido Parvis, Fabio Benedetti, Saveria Capria, Paolo Corradini, Corrado Tarella, Tiziano Barbui |
Journal | Blood
(Blood)
Vol. 102
Issue 2
Pg. 749-55
(Jul 15 2003)
ISSN: 0006-4971 [Print] United States |
PMID | 12663455
(Publication Type: Evaluation Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
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Chemical References |
- Antibodies, Monoclonal
- Antibodies, Monoclonal, Murine-Derived
- Cytarabine
- Rituximab
- Cyclophosphamide
- Mitoxantrone
- Melphalan
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Topics |
- Adult
- Antibodies, Monoclonal
(pharmacology)
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols
(administration & dosage, therapeutic use)
- Bone Marrow
(pathology)
- Bone Marrow Purging
(methods)
- Combined Modality Therapy
- Cyclophosphamide
(administration & dosage)
- Cytarabine
(administration & dosage)
- Disease-Free Survival
- Female
- Follow-Up Studies
- Hematopoietic Stem Cell Mobilization
- Humans
- Leukapheresis
- Lymphoma, Mantle-Cell
(drug therapy, pathology, therapy)
- Male
- Melphalan
(administration & dosage)
- Middle Aged
- Mitoxantrone
(administration & dosage)
- Neoplasm, Residual
- Peripheral Blood Stem Cell Transplantation
- Polymerase Chain Reaction
- Remission Induction
- Retrospective Studies
- Rituximab
- Survival Rate
- Transplantation, Autologous
- Treatment Outcome
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