Alternating R‐CHOP and R‐cytarabine is a safe and effective regimen for transplant‐ineligible patients with a newly diagnosed mantle cell lymphoma

Abstract

Implementation of cytarabine into induction therapy became standard of care for younger patients with mantle cell lymphoma (MCL). On the basis of its beneficial impact, many centers incorporated cytarabine at lower doses also into first-line treatments of elderly patients. We conducted a multicenter observational study that prospectively analyzed safety and efficacy of alternating 3 + 3 cycles of R-CHOP and R-cytarabine for newly diagnosed transplant-ineligible MCL patients. A total of 73 patients were enrolled with median age 70 years. Most patients had intermediate (39.7%) and high-risk (50.7%) disease according to MCL international prognostic index. Rituximab maintenance was initiated in 58 patients. Overall response rate reached 89% by positron emission tomography-computed tomography, including 75.3% complete remissions. Two patients (2.7%) did not complete the induction therapy because of toxicity. Three patients (4.1%) were considered nonresponders, which led to therapy change before completion of induction. Estimated progression-free survival and overall survival were 51.3% and 68.6% at 4 years, respectively. Mantle cell lymphoma international prognostic index, bulky disease (≥ 5 cm), and achievement of positron emission tomography-negativity independently correlated with progression-free survival. Grade 3 to 4 hematologic and nonhematologic toxicity was documented in 48% and 20.5% patients, respectively. Alternation of R-CHOP and R-cytarabine represents feasible and very effective regimen for elderly/comorbid MCL patients. This study was registered at GovTrial (clinicaltrials.gov) NCT03054883.

The Role of 18F-FDG PET/CT in Staging and Prognostication of Mantle Cell Lymphoma: An Italian Multicentric Study

“…In our paper, we tried to validate this score also in MCL, obtaining some strong results; patients with a negative end-of-treatment PET/CT (DC1-3) had significantly longer PFS than patients with a positive PET/CT (DC4,5). Similar results in small cohort of patients were reported by other authors [20,22,28]. However, this evidence was not confirmed for OS, where DC seems to not influence the outcome survival.…”

Potential loss of prognostic significance of minimal residual disease assessment after R‐CHOP‐based induction in elderly patients with mantle cell lymphoma in the era of rituximab maintenance

“…We have recently published results of a multicenter prospective observational trial that analyzed safety and efficacy of alternating R‐CHOP and R‐cytarabine in 73 transplant‐ineligible patients with newly dg. MCL . With the median follow‐up of the living patients 4.5 years (by October 14, 2017), median PFS of the whole cohort (of 73 patients) was 4.4 years (Figure A).…”

“…We have recently published results of an observational trial that evaluated safety and efficacy of alternation R‐CHOP/R‐cytarabine (3 + 3 cycles) in transplant‐ineligible patients with MCL . Restaging procedures included MRD assessment from PB and BM after 3 and 6 cycles of the induction therapy.…”

“…Mantle cell lymphoma is an incurable subtype of B‐NHL . Currently, the front‐line treatment of elderly/comorbid MCL patients is based either on R(ituximab)‐cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP) or on R‐bendamustine, with or without implementation of high‐dose cytarabine . Landmark European MCL Network study demonstrated significant survival benefit of RM over observation or interferon alpha .…”

Bulky primary tibia mantle cell lymphoma achieved complete remission with CHOP and DHAP plus rituximab: A case report

“…MIPI, Ki-67 index and bulky mass are effective markers in evaluating patient prognosis in MCL (8). In the current case, the patient was classified to have a low-risk prognosis according to the MIPI.…”