VcR-CVAD Induction Chemotherapy Followed by Maintenance Rituximab Produces Durable Remissions in Mantle Cell Lymphoma: A Wisconsin Oncology Network Study

Julie E. Chang, Lakeesha L. Carmichael, Kyung Mann Kim, Christopher Peterson, David T. Yang, Anne M. Traynor, Jae E. Werndli, Michael S. Huie, Thomas A. McFarland, Michael Volk, Jules Blank, Natalie S. Callander, Walter L. Longo, Brad S. Kahl

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10 Scopus citations

Abstract

VcR-CVAD with maintenance rituximab is an intermediate-intensity regimen for older and younger patients with mantle cell lymphoma (MCL). Thirty patients were treated, with a primary endpoint of response and secondary endpoints of progression-free and overall survival. After a median follow-up of 7.8 years, no relapses were observed beyond 6 years. VcR-CVAD has long-term outcomes comparable with more intensive chemotherapy regimens. Introduction VcR-CVAD was developed as an intermediate-intensity induction regimen with maintenance rituximab (MR) to improve remission durations after first-line therapy for mantle cell lymphoma (MCL) in older and younger patients with MCL. Patients and Methods Patients with previously untreated MCL received VcR-CVAD induction chemotherapy for 6 cycles (21-day cycles). Patients achieving at least a partial response received rituximab consolidation (375 mg/m 2 × 4 weekly doses) and MR (375 mg/m 2 every 12 weeks × 20 doses). The primary endpoints were overall and complete response (CR), and the secondary endpoints were progression-free survival (PFS) and overall survival (OS). Thirty patients were enrolled, with a median age of 61 years. There was an even distribution of patients < 60 years and ≥ 60 years. Mantle cell lymphoma international prognostic index medium- or high-risk disease was present in 60%. The overall response rate observed was 90% (77% CR/unconfirmed CR). After a median follow-up of 7.8 years, the 6-year PFS and OS were 53% and 70%, respectively. There was no difference in 6-year PFS or OS between the younger (age < 60 years) and older (age ≥ 60 years) subgroups. In a univariate analysis, lactate dehydrogenase, when analyzed for interaction with age, had a significant effect on PFS outcomes at 6 years. There were no pretreatment variables determined to have a significant effect on OS outcomes at 6 years. Conclusions Long-term outcomes with VcR-CVAD are comparable with more intensive inductions and consolidation approaches. MCL is biologically heterogeneous, and durable remission can be achieved with intermediate intensity therapy. MR appears to contribute to these excellent outcomes.

Original languageEnglish
Pages (from-to)e61-e67
JournalClinical Lymphoma, Myeloma and Leukemia
Volume18
Issue number1
DOIs
StatePublished - Jan 2018

Keywords

  • Autologous stem cell transplant
  • Bortezomib
  • Hyper-CVAD
  • MIPI score
  • Non-Hodgkin lymphoma

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