Activity of Rituximab plus Cyclophosphamide, Doxorubicin/Mitoxantrone, Vincristine and Prednisone in Patients with Relapsed MALT Lymphoma

Abstract

Background: Various chemotherapeutic agents as well as the anti-CD20 antibody rituximab (R) have been tested in patients with mucosa-associated lymphoid tissue (MALT) lymphoma, but no standard chemotherapeutic regimen has emerged so far. Judging from the data obtained in various types of lymphoma, the activity of R appears to be enhanced by combination with chemotherapy. As no data on this topic exist for MALT lymphoma, we have retrospectively analysed our experience with R plus cyclophosphamide, doxorubicin/mitoxantrone, vincristine and prednisone (R-CHOP/R-CNOP) in patients with relapsed MALT lymphoma. Patients and Methods: A total of 26 patients were identified, 15 were administered R-CHOP while 11 patients were given R-CNOP due to age >65 years or pre-existing cardiac conditions. Cycles were repeated every 21 days, and restaging was performed after 4 cycles of therapy. In case of complete remission, 2 further cycles were administered for consolidation while patients achieving partial remission or stable disease after restaging were given 4 further courses. Results: A total of 170 cycles were administered to our patients (median 6, range 2–8). Twenty of the 26 patients (77%) achieved a complete remission and 6 (23%) a partial remission. Toxicities were mainly haematological, with WHO grade III/IV leukocytopenia occurring in 5 patients. After a median follow-up of 19 months (range 10–45), all patients are alive: 22 are in ongoing remission, while 4 have relapsed between 12 and 19 months after treatment. Conclusions: Our data demonstrate a high activity of R-CHOP/R-CNOP in relapsing MALT lymphoma irrespective of prior therapy.

Targeting Bruton tyrosine kinase with ibrutinib in relapsed/refractory marginal zone lymphoma

“…10 In another retrospective study in 14 patients with relapsed extranodal MZL (no prior systemic antitumor therapy in 6 patients; 43%), bendamustine combined with rituximab (BR) showed an ORR of 93% (CR in 71%) and durable remissions, with 12 patients (86%) remaining in remission at a median follow-up of 23 months. 27 Grade 3-4 cytopenias occurred in 29% of these patients.…”

“…2,3 Treatment of MZL ranges from localized to palliative approaches; however, for advanced disease, treatments range from single-agent chemotherapy or anti-CD20 monoclonal antibody to a more aggressive approach with chemoimmunotherapy. [4][5][6][7][8][9][10][11][12] Advanced disease is generally incurable, and the majority of patients will experience serial relapses. At the time of study initiation, no therapeutic agent was US Food and Drug Administration (FDA)-approved specifically for MZL, and no standard treatment existed.…”

A phase II study of bortezomib in patients with MALT lymphoma

“…In view of the relatively indolent nature of MALT lymphoma with the respective long durations of treatment and survival, the issue of both acute and delayed toxicity is indeed a substantial one. As has already been discussed with other chemotherapeutic regimens in MALT lymphoma, 21,22 regimens with low toxicity should preferentially be applied, and promising results have been obtained with fludarabine-based 22 therapies or cladribine, 5 with response rates at prolonged follow-up reaching 100% in selected subgroups of patients. Especially with cladribine, a 100% CR rate was seen in gastric lymphoma, while extragastric localizations had a much less favorable course.…”

Effect of L-carnitine against acute mitoxantrone toxicity in mice

“…Numerous papers dealing with chemotherapy management of neoplastic diseases have reported mitoxantrone to be an important modern therapeutic both in studies involving mice [1,2] and also humans [3][4][5][6]. Reported adverse effects -nausea, vomiting, myelotoxicity, anemia, cardiotoxicity and immunosuppression -are usually mild or moderate in comparison to other drugs of the same group [6,7].…”

“…Reported adverse effects -nausea, vomiting, myelotoxicity, anemia, cardiotoxicity and immunosuppression -are usually mild or moderate in comparison to other drugs of the same group [6,7]. For mitoxantrone, as with many other chemotherapeutic regimens, there is also a relationship between the dose of the drug and its pharmacological response.…”