Maintenance rituximab following induction chemoimmunotherapy may prolong progression-free survival in mantle cell lymphoma: a pilot study from the Wisconsin Oncology Network

Kahl, Brad S.; Longo, Walter L.; Eickhoff, Jens; Zehnder, James L.; Jones, Carol D.; Blank, Jonathan L.; McFarland, Thomas; Bottner, Wayne A.; Rezazedeh, Hamied; Werndli, Jae; Bailey, Howard

doi:10.1093/annonc/mdl127

Cited by 99 publications

(64 citation statements)

References 33 publications

(42 reference statements)

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“…12 It is, however, worth noting that a less appreciated detail of the Nordic study group has been the continued treatment of minimal residual disease with R. To our knowledge, there is only one report of R maintenance in MCL in the frontline setting; that trial design incorporated a dose-reduced version of R-HyperCVAD. 15 Ours is the first cohort reported with R maintenance following a full-dose R-HyperCVAD treatment plan.…”

Section: Discussionmentioning

confidence: 99%

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Potential prolongation of PFS in mantle cell lymphoma after R-HyperCVAD: auto-SCT consolidation or rituximab maintenance

Ahmadi

McQuade

Porter

et al. 2011

Bone Marrow Transplant

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We retrospectively analyzed 44 patients undergoing first-line treatment for mantle cell lymphoma with R-HyperCVAD, with or without rituximab (R) maintenance or auto-SCT. The primary study end point was PFS; secondary end point was overall survival. Median follow up for all patients was 3.3 years. Median age was 54 years, and 95% (n ¼ 42) were stage III or IV at diagnosis. In all, 17 patients underwent consolidative auto-SCT and 12 patients received R maintenance. The overall response rate was 95%, with 91% achieving complete response (CR). Median PFS for all patients was 3.5 years. Median PFS was 2.3 years for patients treated with R-HyperCVAD alone vs 3.9 years (P ¼ 0.02) with R-HyperCVAD þ R maintenance and 4.5 years (P ¼ 0.01)

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Section: Discussionmentioning

confidence: 99%

“…15 Another randomized trial conducted by the German Low Grade Lymphoma Study Group compared 1 year of R maintenance with observation in patients with relapsed follicular lymphoma and MCL. 16 The results suggested an added benefit for R maintenance in the treatment of MCL.…”

Section: Introductionmentioning

confidence: 99%

Potential prolongation of PFS in mantle cell lymphoma after R-HyperCVAD: auto-SCT consolidation or rituximab maintenance

Ahmadi

McQuade

Porter

et al. 2011

Bone Marrow Transplant

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“…Compared to a historical control without the cytarabine, the results were much improved with the regimen as outlined [41]. In a small pilot trial in an older population, the rituximab-Hyper CVAD regimen without the methotrexate or cytarabine, but with maintenance rituximab demonstrated an ORR of 77% and a median PFS of 37 months [42]. Another approach has been for patients to receive R-CHOP 3 three cycles, then Rituximab, cisplatin, cytarabine, dexamethasone (R-DHAP) 3 3, followed by high dose chemotherapy and ASCT [43].…”

Section: Initial Management Of a Young Symptomatic Patientmentioning

confidence: 97%

“…Since the R-HyperCVAD alternating with methotrexate/cytarabine is difficult to administer, modifications which drop the methotrexate portion [41] or drop both the methotrexate and cytarabine have been tested [42]. In the study from Geisler et al [41], 160 younger MCL patients received rituximab 1 maxi-CHOP, alternating with rituximab 1 cytarabine.…”

Section: Initial Management Of a Young Symptomatic Patientmentioning

confidence: 99%

Mantle cell lymphoma: 2015 update on diagnosis, risk‐stratification, and clinical management

Vose

2015

American J Hematol

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Disease Overview: Mantle cell lymphoma (MCL) is a non‐Hodgkin lymphoma characterized by involvement of the lymph nodes, spleen, blood and bone marrow with a short remission duration to standard therapies and a median overall survival (OS) of 4‐5 years.Diagnosis: Diagnosis is based on lymph node, bone marrow, or tissue morphology of centrocytic lymphocytes, small cell type, or blastoid variant cells. A chromosomal translocation t (11:14) is the molecular hallmark of MCL, resulting in the overexpression of cyclin D1. Cyclin D1 is detected by immunohistochemistry in 98% of cases. The absence of SOX‐11 or a low Ki‐67 may correlate with a more indolent form of MCL. The differential diagnosis of MCL includes small lymphocytic lymphoma, marginal zone lymphoma, and follicular lymphoma.Risk Stratification: The MCL International Prognostic Index (MIPI) is the prognostic model most often used and incorporates ECOG performance status, age, leukocyte count, and lactic dehydrogenase. A modification of the MIPI also adds the Ki‐67 proliferative index if available. The median OS for the low‐risk group was not reached (5‐year OS of 60%). The median OS for the intermediate risk group was 51 months and 29 months for the high risk group.Risk‐Adapted Therapy: For selected indolent, low MIPI MCL patients, initial observation may be appropriate therapy. For younger patients with intermediate or high risk MIPI MCL, aggressive therapy with a cytotoxic regimen ± autologous stem cell transplantation should be considered. For older MCL patients with intermediate or high risk MIPI, combination chemotherapy with R‐CHOP, R‐Bendamustine, or a clinical trial should be considered. In addition, rituximab maintenance therapy may prolong the progression‐free survival. At the time of relapse, agents directed at activated pathways in MCL cells such as bortezomib (NFkB inhibitor), lenalidamide (anti‐angiogenesis) and Ibruitinib (Bruton's Tyrosine Kinase [BTK] inhibitor) have demonstrated excellent clinical activity in MCL patients. Autologous or allogeneic stem cell transplantation can also be considered in young patients. Clinical trials with novel agents are always a consideration for MCL patients. Am. J. Hematol. 90:740–745, 2015. © 2015 Wiley Periodicals, Inc.

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“…In an effort to maintain efficacy while reducing toxicity, Kahl et al 20 eliminated the mid-treatment high-dose MTX and cytarabine in R-hyperCVAD while continuing the other agents. Among 22 patients with previously untreated MCL, the OR was 77% with a CR rate of 64%.…”

Section: Chemotherapy For MCLmentioning

confidence: 99%

Hematopoietic SCT for mantle cell lymphoma: is it the standard of care?

Nabhan

Ragam

Bitran

et al. 2010

Bone Marrow Transplant

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The role of hematopoietic SCT (HSCT) in mantle cell lymphoma (MCL) remains controversial. Most studies that support the utility of this approach were small phase II single-institution studies with highly selected patient populations. Furthermore, recent evidence suggesting initial observation as opposed to immediate therapy in MCL, coupled with the availability of newer therapeutic agents, complicates the role of HSCT and argues for conducting large phase III studies. In this review, we discuss the limitation of current evidence and the lack of large definitive studies. We then analyze the data on HSCT in relapsed MCL and as a frontline approach propose applying the new prognostic index, MIPI (MCL International Prognostic Index), in the decision making.

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Maintenance rituximab following induction chemoimmunotherapy may prolong progression-free survival in mantle cell lymphoma: a pilot study from the Wisconsin Oncology Network

Abstract: In a multicenter trial, modified R-hyperCVAD was tolerable and effective induction therapy for untreated MCL. Maintenance rituximab appeared to prolong PFS without increasing toxicity.

Cited by 99 publications

References 33 publications

Potential prolongation of PFS in mantle cell lymphoma after R-HyperCVAD: auto-SCT consolidation or rituximab maintenance

Potential prolongation of PFS in mantle cell lymphoma after R-HyperCVAD: auto-SCT consolidation or rituximab maintenance

Mantle cell lymphoma: 2015 update on diagnosis, risk‐stratification, and clinical management

Hematopoietic SCT for mantle cell lymphoma: is it the standard of care?

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