Risk - adapted intensive induction therapy, autologous stem cell transplantation, and rituximab maintenance allow to reach a high 7-year survival rate in patients with mantle cell lymphoma

Risk - adapted intensive induction therapy, autologous stem cell transplantation, and rituximab maintenance allow to reach a high 7-year survival rate in patients with mantle cell lymphoma

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Mantle cell lymphoma (MCL) is aggressive B-cell neoplasm diagnosed predominantly among older men.R-CHOP-like regimens allow to achieve high response rate, but the overall survival (OS) are disappointingly short - 3-4 years.An addition of high - dose cytarabine to the upfront therapy and autoSCT significantly improved outcomes but remain feasible largely for medically fit patients.Based on the activity and good tolerance of gemcitabine - oxaliplatin schemes in relapsed and refractory MCL patients, we developed an alternative first - line course for patients who are not eligible for R-HD-MTX-AraC.Aim.

Assess toxicity and efficacy of R-DA-EPOCH/ R-HD-MTX-AraC and R-DA-EPOCH/R-GIDIOX schemes, autoSCT and R-maintenance in untreated MCL patients.Materials and methods.47 untreated MCL patients from 6 centers were enrolled in prospective study between April 2008 and September 2013.All patients have stage II-V; ECOG 0-3; median age 55 years (29-64); Male/Female 76%/24%.MIPIb: 28% low, 33% intermediate and 39% high risk.

Following 1st R-EPOCH patients were assigned to receive either R-DA-EPOCH/ R-HD-MTX-AraC or R-DA-EPOCH/ R-GIDIOX regimen.In the absence of renal failure, spidertattooz.com hematological toxicity grade 4 more than 3 days and severe infections patients received R-HD-MTX-AraC scheme (R 375 mg/m2 Day 0, Methotrexate 1000 mg/m2/24 hours Day 1, AraC 3000 mg/m2 q 12 hrs Days 2-3).Patients who had at least one of these complications received R-GIDIOX scheme (R 375 mg/m2 day 0, gemcitabine 800 mg/m2 days 1 and 4, ifosfamide 1000 mg/m2 days 1-5, dexamethasone 10 mg/m2 IV days 1-5, irinotecan 100 mg/m2 day 3, oxaliplatin 120 mg/m2 day 2).Subsequently these courses were alternating with R-DA-EPOCH in each arm of the protocol.Depending on the time of achieving CR patients received 6 or 8 iphone 14 price chicago courses, unless they progressed on therapy.

Those patients who achieved PR/CR/CRu underwent autoSCT (BEAM-R).Post - transplant R-maintenance was administered for 3 years (R - 375 mg/m2 every 3 months).Results.29/47 patients were treated on R-HD-MTX-AraC arm (median 50 years; MIPIb: 35.7% low, 28.

6% intermediate, 35.7% high risk) and 18/47 patients were on R-GIDIOX arm (median 60 years; MIPIb: 16.7% low, 38.9% intermediate, 44.4% high risk).

In R-HD-MTX-AraC arm CR rate was 96.5%.In R-GIDIOX arm OR and CR rates were 94.4% and 77.7% respectively.

Main hematological toxicity of R-GIDIOX was leukopenia gr.4 occurred in 74.1%.With median follow - up of 76 months, the estimated 7-years OS and EFS in R-HD-MTX-AraC arm are 76% and 57% respectively.In R-GIDIOX arm the estimated 7-years OS and EFS are 59% and 44%, respectively.

There are no statistical differences in EFS (p=0.47) and OS (p=0.06) between two arms.Conclusions.The use of a risk - adapted strategy allowed 95.

7% of patients achieve PR/CR/CRu, performed autoSCT and begun R-maintenance therapy with rituximab.None of the patients needed a premature discontinuation of therapy because of unacceptable toxicity.The performance of autoSCT and R-maintenance apparently allowed to partially offset differences in the intensity of induction therapy and to maintain comparable results of therapy in both induction arms.