TY - JOUR
T1 - VcR-CVAD Induction Chemotherapy Followed by Maintenance Rituximab Produces Durable Remissions in Mantle Cell Lymphoma
T2 - A Wisconsin Oncology Network Study
AU - Chang, Julie E.
AU - Carmichael, Lakeesha L.
AU - Kim, Kyung Mann
AU - Peterson, Christopher
AU - Yang, David T.
AU - Traynor, Anne M.
AU - Werndli, Jae E.
AU - Huie, Michael S.
AU - McFarland, Thomas A.
AU - Volk, Michael
AU - Blank, Jules
AU - Callander, Natalie S.
AU - Longo, Walter L.
AU - Kahl, Brad S.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/1
Y1 - 2018/1
N2 - 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.
AB - 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.
KW - Autologous stem cell transplant
KW - Bortezomib
KW - Hyper-CVAD
KW - MIPI score
KW - Non-Hodgkin lymphoma
UR - http://www.scopus.com/inward/record.url?scp=85035194522&partnerID=8YFLogxK
U2 - 10.1016/j.clml.2017.10.006
DO - 10.1016/j.clml.2017.10.006
M3 - Article
C2 - 29191715
AN - SCOPUS:85035194522
SN - 2152-2650
VL - 18
SP - e61-e67
JO - Clinical Lymphoma, Myeloma and Leukemia
JF - Clinical Lymphoma, Myeloma and Leukemia
IS - 1
ER -