Previously untreated mantle cell lymphoma (MCL) is an uncommon disorder with a poor prognosis when treated with CHOP-like (cyclophosphamide [Cytoxan, Neosar], doxorubicin(Drug information on doxorubicin) HCl, vincristine [Oncovin], prednisone(Drug information on prednisone)) regimens. Typically the complete remission (CR) rate is 20% to 30%, median failure-free survival (FFS) is 10 to 16 months, and median overall survival (OS) is 3 years.
Using the hyper-CVAD (fractionated cyclophosphamide(Drug information on cyclophosphamide), doxorubicin, vincristine, dexamethasone(Drug information on dexamethasone))/methotrexate/cytarabine regimen, which includes stem cell transplantation, in patients less than 66 years old, we previously described a CR rate of 100% as well as prolonged FFS and OS (J Clin Oncol 16:3803, 1998). In March 1999 we started a new trial using the same hyper-CVAD regimen but with two major modifications: (1) we added rituximab(Drug information on rituximab) (Rituxan) at 375 mg/m² on day 1 of the first six courses, and (2) we stopped doing stem cell transplantation for patients who achieved CR within six courses of treatment.
Pretreatment requirements included diagnosis of untreated MCL (nodular,
diffuse, or blastic variant) as well as adequate organ function. There was no
Ann Arbor stage or age restriction and patients with leukemic presentation were
eligible. Patients with HIV infection or evidence of central nervous system
disease were excluded. A total of 92 patients have been registered. Median age
was 61 years and 100% were stage IV. Involvement of the spleen, bone marrow, and
peripheral blood was present in 39%, 92%, and 47% of patients, respectively.
Systematic upper and lower endoscopies showed that 88% had involvement of the
gastrointestinal tract. Diffuse histology was present in 71%, 16% of which had a
blastic variant. Fifty-nine patients have had at least six cycles and will be
used as the denominator for response assessment.
With a median follow-up of 14 months, results after six cycles of chemotherapy are summarized in the table above and compared with prior regimens. There were no statistically significant differences in outcome. Toxicity was mainly hematologic (60% grade 4), and there were 11% grade 3 infections.
CONCLUSION: Our current results with R-HCVAD confirm our previous experience with hyper-CVAD when compared with CHOP. In this study, R-HCVAD without stem cell transplantation appears equivalent to hyper-CVAD in patients younger than 66 years old. These results are preliminary, and more follow-up is needed.
Click here to read Dr. Bruce Cheson's commentary on this abstract.
A 52-year-old man presented with an erythematous lesion in the axilla of unknown duration. Surgical excision was performed. What is your diagnosis?
