Cladribine plus rituximab is an effective therapy for newly diagnosed mantle cell lymphoma

Abstract

Mantle cell lymphoma (MCL) is a non-Hodgkin lymphoma that is incurable with standard chemotherapy. There is no consensus on the best initial therapy, especially for elderly patients, who are not candidates for aggressive treatment approaches. Current National Comprehensive Cancer Network (NCCN) treatment guidelines include rituximab (R) plus cladribine for the initial treatment of MCL. However, few data are available to substantiate this recommendation. Therefore, to further define the role of R-cladribine for the initial treatment of MCL, we performed a retrospective chart review of 31 patients with MCL (median age, 67) treated with R-cladribine. The majority of responding patients also received R maintenance. The overall response rate was 87%, with 61% of patients achieving a complete remission (CR/CRu). The estimated median follow-up was 32.5 months, median PFS was 37.5 months, and median OS was 85.2 months. One of 19 (5.3%) subjects in CR/CRu relapsed (median follow-up of 23 months). CR/CRu was associated with improved survival (p < 0.0001), while a high mantle cell international prognostic index (MIPI) was associated with worse survival (p = 0.05). There was one toxic death (neutropenic pseudomonal sepsis) related to treatment. R-cladribine is an effective therapy for previously untreated MCL, and these results validate the use of R-cladribine for the initial treatment of MCL.

Non-Hodgkin’s Lymphomas, Version 4.2014

“…40 In a recent retrospective study in patients with previously untreated MCL (n=31), cladribine combined with rituximab yielded an ORR of 87% (61% CR/CRu) with a median PFS and OS of 37.5 and 85 months, respectively. 41 It should be noted that in this study, most responding patients had received postinduction maintenance therapy with rituximab.…”

“…39–41 In trials conducted by the North Central Cancer Treatment group, the ORR and median PFS for single agent cladribine were 81% (42% CR) and 14 months, respectively, for previously untreated patients (n=26); the combination of cladribine and rituximab as initial therapy (n=29) resulted in an ORR of 66% (52% CR) and median PFS of 12 months. 39 In a small trial in patients with previously untreated and pretreated MCL (n=12), cladribine alone induced an ORR of 58% (25% CR) with a median time to progression of 19 months.…”

Mantle Cell Lymphoma: A Clinically Heterogeneous Disease in Need of Tailored Approaches

“…After a median followup of 32.5 months, the median PFS and OS were 37.5 and 85 months, respectively. Among those who obtained a complete response, only 1 has relapsed after median followup of 23 months 64 .…”

Current Approaches to Epigenetic Therapy for the Treatment of Mantle Cell Lymphoma

“…There was one toxic death (neutropenic pseudomonal sepsis) related to treatment. RC is an effective therapy for previously untreated MCL, and these results validate the use of RC for the initial treatment of MCL [ 29 ] .…”