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Effect of front-line therapy with either high-dose therapy and autologous stem cell rescue (HDT/ASCR) or dose-intensive therapy (R-Hypercvad) on outcome in mantle cell lymphoma (MCL).
Background: There is still no consensus in the management of newly diagnosed MCL and randomized controlled data is unavailable to guide treatment decisions. Recent analyses strongly support the use of dose-intensive strategies or high dose therapy approaches in the frontline setting. Methods: We conducted a retrospective cohort analysis to describe and compare the survival experiences of MCL patients treated in the first-line setting at our institution with R-HCVAD (42 pts) vs. induction chemotherapy followed by consolidative ASCT (35 pts) vs. standard-dose chemotherapy±rituxan (mostly CHOP±rituximab) (44 pts). The primary study endpoint was OS assessed by chart review and confirmed by SSDI database. Results: 111 patients with newly diagnosed MCL were available for this analysis, representing 38 failure events and 3,858 total months at risk. The groups were comparable in terms of their age, ECOG PS, LDH, WBC, MIPI score and Ki-67 at baseline. Median OS for the cohort was 65 months. Median OS for the groups were: standard-dose chemotherapy ±rituximab (45 months), R-HCVAD (74 months) and ASCT (92 months). Patients treated with either R-HCVAD or ASCT had a superior OS when compared to patients treated with standard- dose chemotherapy ±rituximab (p=.02, p=.005, LR test). We did not detect a survival advantage in patients treated with induction chemotherapy followed by consolidative ASCT vs. R-HCVAD (p=.54, LR test). Conclusions: (R-)CHOP was inferior to both R-HyperCVAD and R- CHOP+HDT/ASCR, which both lead to superior outcome and provide a platform to build up either by the integration of novel therapies in combination or as part of a maintenance strategy.
Abstracts by T. Feldman:
A new predictive model based on age, pretreatment LDH, and post-therapy PET-CT in patients with MCL treated with dose-intensive strategies.Meeting: 2011 ASCO Annual Meeting | Abstract No: 8051
The association between the GOELAMS MCL-PET prognostic index and survival in patients treated with rituximab-hypercvad (R-HyCVAD) or high-dose therapy with autologous stem cell rescue (HDT/ASCT).Meeting: 2011 ASCO Annual Meeting | Abstract No: 8050
Effect of early chemotherapy intensification with BEACOPP in high-risk, interim-PET positive, advanced-stage Hodgkin lymphoma on overall treatment outcome of ABVD.Meeting: 2010 ASCO Annual Meeting | Abstract No: 8006