CHOP and DHAP plus rituximab followed by autologous stem cell transplantation in mantle cell lymphoma: a phase 2 study from the Groupe d'Etude des Lymphomes de l'Adulte

Blood. 2013 Jan 3;121(1):48-53. doi: 10.1182/blood-2011-09-370320. Epub 2012 Jun 20.

Abstract

Treatment of mantle cell lymphoma (MCL) in younger patients remains a challenge. We report results of a phase 2 trial using cytarabine and rituximab as induction regimen before autologous stem cell transplantation. Patients younger than 66 years with stage 3 or 4 MCL were included. Treatment consisted of 3 courses of CHOP(21) with rituximab at the third one and 3 of R-DHAP. Responding patients were eligible for autologous stem cell transplantation with TAM6 or BEAM. Sixty patients were included. Median age was 57 years. Characteristics of patients were: BM involvement 85%, leukemic disease 48%, gastrointestinal involvement 52%, Performance Status > 16%, lactate dehydrogenase > 1N 38%, Mantle Cell Lymphoma International Prognostic Index (low 55%, intermediate 38%, high 13%). The overall response rate was 93% after (R)-CHOP and 95% after R-DHAP. Although uncommon after (R)-CHOP (12%), 57% of patients were in complete response after R-DHAP. With median follow-up of 67 months, median event-free survival is 83 months, and median overall survival is not reached. Five-year overall survival is 75%. Comparison with a previous study without rituximab shows improvement of outcome (median event-free survival, 51 vs 83 months). No toxic death or unexpected toxicities were observed. This study confirms that induction with rituximab and cytarabine-based regimens is safe and effective in MCL patients. This regimen is currently compared with R-CHOP(21) induction in a multicentric European protocol.

Publication types

  • Clinical Trial, Phase II
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antibodies, Monoclonal, Murine-Derived / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Cisplatin / administration & dosage
  • Cisplatin / adverse effects
  • Cyclophosphamide / administration & dosage
  • Cytarabine / administration & dosage
  • Cytarabine / adverse effects
  • Dexamethasone / administration & dosage
  • Dexamethasone / adverse effects
  • Disease-Free Survival
  • Doxorubicin / administration & dosage
  • Female
  • Hematologic Diseases / chemically induced
  • Humans
  • Kaplan-Meier Estimate
  • Kidney Diseases / chemically induced
  • Lymphoma, Mantle-Cell / drug therapy*
  • Lymphoma, Mantle-Cell / surgery
  • Male
  • Melphalan / administration & dosage
  • Middle Aged
  • Neoplasms, Second Primary / epidemiology
  • Peripheral Blood Stem Cell Transplantation*
  • Prednisone / administration & dosage
  • Rituximab
  • Transplantation Conditioning
  • Transplantation, Autologous
  • Treatment Outcome
  • Vincristine / administration & dosage
  • Whole-Body Irradiation

Substances

  • Antibodies, Monoclonal, Murine-Derived
  • Cytarabine
  • Rituximab
  • Vincristine
  • Dexamethasone
  • Doxorubicin
  • Cyclophosphamide
  • Cisplatin
  • Melphalan
  • Prednisone

Supplementary concepts

  • CHOP protocol
  • DHAP protocol