A phase II clinical trial of intensive chemotherapy followed by consolidative stem cell transplant: long‐term follow‐up in newly diagnosed mantle cell lymphoma
Open Access
- 20 December 2007
- journal article
- Published by Wiley in British Journal of Haematology
- Vol. 140 (4), 385-393
- https://doi.org/10.1111/j.1365-2141.2007.06908.x
Abstract
Mantle cell lymphoma (MCL) is associated with high relapse rates and poor survival when treated with conventional chemotherapy, with or without rituximab. We report the long-term follow-up of a phase II clinical trial using a new intensive multiagent chemotherapeutic regimen [cyclophosphamide, teniposide, doxorubicin and prednisone (CTAP) alternating with vincristine and high-dose methotrexate and cytarabine (VMAC)] in newly diagnosed MCL. Following 4–6 cycles of CTAP/VMAC induction, patients aged ≤65 years proceeded to consolidative autologous haematopoietic stem cell transplantation (auto-HSCT), while patients ≤55 years who had a HLA-identical sibling received allogeneic-HSCT (busulfan/cyclophosphamide conditioning for both). Twenty-five untreated MCL patients enrolled on the protocol between 1997 and 2002. Among evaluable patients, overall response rate (ORR) was 74% following induction chemotherapy. Seventeen patients received HSCT (autologous-13/allogeneic-4). On intent-to-treat analysis, ORR for patients who received consolidative HSCT was 100% (complete remission 76%). Therapy was well-tolerated with 4% treatment-related mortality (including HSCT). The 5-year event-free-survival (EFS) and overall survival (OS) for all patients was 35% and 50% respectively. Furthermore, at 66-months median follow-up, the 5-year EFS and OS for patients who received consolidative auto-HSCT was 54% and 75% respectively. Patients who received auto-HSCT had improved outcomes compared to no auto-HSCT (EFS P = 0·001; OS P = 0·0002). CTAP/VMAC induction followed by consolidative auto-HSCT for newly diagnosed MCL is associated with high ORR and durable survival.Keywords
This publication has 36 references indexed in Scilit:
- Combined cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP) improves response rates but not survival and has lower hematologic toxicity compared with combined mitoxantrone, chlorambucil, and prednisone (MCP) in follicular and mantle cell lymphomasCancer, 2006
- Frontline therapy with rituximab added to the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly improves the outcome for patients with advanced-stage follicular lymphoma compared with therapy with CHOP alone: results of a prospective randomized study of the German Low-Grade Lymphoma Study GroupBlood, 2005
- Early consolidation by myeloablative radiochemotherapy followed by autologous stem cell transplantation in first remission significantly prolongs progression-free survival in mantle-cell lymphoma: results of a prospective randomized trial of the European MCL NetworkPublished by American Society of Hematology ,2005
- Rituximab consolidation after high-dose chemotherapy and autologous blood stem cell transplantation in follicular and mantle cell lymphoma: a prospective, multicenter phase II studyAnnals of Oncology, 2004
- Long-term follow-up of autologous stem cell transplantation in patients with diffuse mantle cell lymphoma in first disease remissionCancer, 2003
- Cerebrospinal Fluid Involvement in Mantle Cell LymphomaLaboratory Investigation, 2002
- Rituximab and CHOP Induction Therapy for Newly Diagnosed Mantle-Cell Lymphoma: Molecular Complete Responses Are Not Predictive of Progression-Free SurvivalJournal of Clinical Oncology, 2002
- High-dose therapy with stem cell transplantation for mantle cell lymphoma: results and prognostic factors, a single center experienceBone Marrow Transplantation, 1998
- Multicentre randomized therapeutic trial for advanced centrocytic lymphoma: Anthracycline does not improve the prognosisHematological Oncology, 1989
- Nonparametric Estimation from Incomplete ObservationsJournal of the American Statistical Association, 1958