Page 1682 - Williams Hematology ( PDFDrive )

1656 Part XI: Malignant Lymphoid Diseases Chapter 100: Mantle Cell Lymphoma 1657

TABLE 100–2. Conventional Immuno-Chemotherapy for Mantle Cell Lymphoma
Number of Median PFS
Author (Year) Phase Patients Regimen ORR% (CR%) (Months) 2-Year OS (%)
Howard (2002) 33 II 40 R-CHOP 96 (48) 17 95 (3 years)
Lenz (2005) 34 III 112 CHOP 75 (7) 14 (TTF) 77
R-CHOP 94 (34) 21 (TTF) 77
Herold (2008) 35 III 90 MCP 63 (15) 18 52 (4 years)
R-MCP 71 (32) 20 55 (4 years)
Gressin (2010) 37 II 113 R-VAD-C 73 (48) 18 (no ASCT) 62 (3 years)
58 (ASCT)
Sachenes (2011) 38 II 20 R-chlorambucil 95 (90) 89% (3 years) 95 (3 years)
Kenkra (2011) 36 II 22 R-hyperCVAD 77 (64) 38 62 (4 years)
R maintenance
Kluin-Nelemans III 485 R-CHOP 86 (34) 28 (TTF) 62 (4 years)
(2012) 39 R-FC 78 (40) 26 (TTF) 47 (4 years)
274 I maintenance NA 29% (4 year DR) 67 (4 years)
R maintenance 58% (4 year DR) 79 (4 years)
Smith (2012) 40 II 50 R-CHOP 64 (46) 31 (TTF) 73 (5 years)
90Y-Ibritumumab
Rummel (2013) 41 III 94 R-CHOP 91 (30) 21 No difference
BR 93 (40) 35
Visco (2013) 42 II 20 R-BAC 100 (95) 95% (2 years) 93
Ruan (2011) 93 II 35 R-CHOP + bortezomib 91 (72) 44% (2 years) 86
Houot (2012) 99 II 29 R-doxorubicin/ 79 (59) 26 69
dexamethasone/
chlorambucil +
bortezomib
Chang (2014) 59A II 75 R-hyperCVAD + 95 (68) 67% (3 years) 91 (3 years)
bortezomib
R maintenance
Robak (2015) 98 III 487 R-CHOP 89 (53) 14 54 (4 years)
R-CHP + bortezomib 92 (42) 25 64 (4 years)
Inwards (2014) 101 I 17 R-cladribine + 94 (53) 19 65
temsirolimus

ASCT, autologous stem cell transplantation; BR, bendamustine and rituximab; CR, complete response; MCP, mitoxantrone, chlorambucil, and
prednisolone; ORR, overall response rate; OS, overall survival; PFS, progression-free survival; R-BAC, rituximab, bendamustine, and cytarabine;
R-CHOP, rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone; R-CHP, rituximab, cyclophosphamide, doxorubicin, and pred-
nisone; R-FC, rituximab, fludarabine, and cyclophosphamide; R-hyperCVAD, rituximab, hyperfractionated cyclophosphamide, vincristine, dox-
orubicin, and dexamethasone; R-MCP, rituximab, mitoxantrone, chlorambucil, and prednisone; TTF, time to treatment failure; Y, yttrium-90.
90
The upper panel includes six studies using immunochemotherapy; the lower panel includes five studies that combine rituximab with other
drugs.

An interim analysis has suggested a benefit from subsequent rituximab RECURRENT AND REFRACTORY DISEASE
maintenance, but further followup is necessary to confirm the superior-
ity of this approach. 53 Salvage Chemotherapy
Alternatively, upfront dose intensification may be applied. The rit- The inherent resistance of MCL to conventional doses of chemother-
uximab plus hyperfractionated cyclophosphamide, vincristine, doxoru- apy becomes especially apparent in relapsed disease. Conventional
bicin, and dexamethasone (R-hyperCVAD) regimen has achieved high immunochemotherapy options, some of them highly effective in first
complete response rates and long-term remissions in various trials. 54–56 line treatment, achieve only short term remissions in relapsed disease.
However, this regimen is hampered by significant therapy-associated (Table 100–4). 42,60–64 Thus, consolidation with ASCT deserves consid-
toxicity, including secondary malignancies, and should only be consid- eration if not already employed in the frontline setting. Unfortunately,
ered in young, fit patients. long-term results of this approach in recurrent/refractory MCL are
rather sobering.

Kaushansky_chapter 100_p1653-1662.indd 1657 9/18/15 5:06 PM