Potential prolongation of PFS in mantle cell lymphoma after R-HyperCVAD: auto-SCT consolidation or rituximab maintenance

• Published in: Bone marrow transplantation (Basingstoke) Vol. 47; no. 8; pp. 1082 - 1086
• Main Authors: Ahmadi, T, McQuade, J, Porter, D, Frey, N, Loren, A W, Goldstein, S C, Svoboda, J, Stadtmauer, E, Schuster, S J, Nasta, S D
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-08-2012; Nature Publishing Group
• Subjects: 692/699/67/1990/291/1621; 692/700/565/2194; 692/700/565/545/576/1855; Age; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antibodies, Monoclonal, Murine-Derived - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Biological and medical sciences; Bone marrow; Bone marrow transplantation; Bone marrow, stem cells transplantation. Graft versus host reaction; Cancer; Care and treatment; Cell Biology; Chemotherapy; Consolidation; Data processing; Diagnosis; Disease-Free Survival; Female; Follow-Up Studies; Hematologic and hematopoietic diseases; Hematology; Humans; Internal Medicine; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoma; Lymphoma, Mantle-Cell - mortality; Lymphoma, Mantle-Cell - pathology; Lymphoma, Mantle-Cell - therapy; Maintenance; Male; Mantle cell lymphoma; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Non-Hodgkin's lymphomas; original-article; Patient outcomes; Patients; Prolongation; Public Health; Retrospective Studies; Rituximab; Stem Cell Transplantation; Stem Cells; Survival Rate; Time Factors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation, Autologous; mantle cell lymphoma; auto-SCT; R-HyperCVAD; rituximab; Antineoplastic agent; Hematology; Stem cell; Hematopoietic cell; Rituximab; B cell neoplasm; Malignant hemopathy; B-Lymphocyte; Monoclonal antibody; Non Hodgkin lymphoma; Consolidation treatment; Immunomodulator; Autograft; Consolidation; Lymphoproliferative syndrome; Immunotherapy; Mantle cell lymphoma; Graft; Immunosuppressive agent; Cancer
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2011.218

We retrospectively analyzed 44 patients undergoing first-line treatment for mantle cell lymphoma with R-HyperCVAD, with or without rituximab (R) maintenance or auto-SCT. The primary study end point was PFS; secondary end point was overall survival.
Median follow up for all patients was 3.3 years. Median age was 54 years, and 95% (
n
=42) were stage III or IV at diagnosis. In all, 17 patients underwent consolidative auto-SCT and 12 patients received R maintenance. The overall response rate was 95%, with 91% achieving complete response (CR). Median PFS for all patients was 3.5 years. Median PFS was 2.3 years for patients treated with R-HyperCVAD alone vs 3.9 years (
P
=0.02) with R-HyperCVAD+ R maintenance and 4.5 years (
P
=0.01) with R-HyperCVAD+ auto-SCT. For patients who did not achieve CR at interim staging, PFS for R-HyperCVAD alone was 1.4 years vs not reached for R-HyperCVAD+ consolidation (either R maintenance or auto-SCT) (
P
=0.02). PFS for patients with CR at interim staging was 3.3 years vs not reached (
P
=0.04) after consolidation. Our data suggest potential improvement in PFS when R-HyperCVAD is consolidated with either R maintenance or auto-SCT. This benefit appears particularly significant in those patients who do not achieve CR at interim restaging.