R-CHOP or R-HyperCVAD with or without autologous stem cell transplantation for older patients with mantle cell lymphoma

Zachary Frosch, Marlise R. Luskin, Daniel J. Landsburg, Stephen J. Schuster, Jakub Svoboda, Alison W. Loren, David L. Porter, Edward A. Stadtmauer, Sunita D. Nasta

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Background Although intensive induction and autologous stem cell transplantation (ASCT) prolong survival in younger patients with mantle cell lymphoma (MCL), benefit in older patients remains uncertain because data supporting these approaches come almost exclusively from younger cohorts. Patients and Methods We reviewed outcomes for 38 patients with MCL aged ≥ 60 years who received R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) (n = 19) or R-HyperCVAD (rituximab plus hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with high-dose methotrexate and cytarabine) (n = 19) with or without ASCT. Results Median progression-free survival (PFS) of R-CHOP + ASCT (3.2 years) and R-HyperCVAD alone (4.0 years) was longer than that for R-CHOP alone (1.6 years; P =.013 and P =.009, respectively). R-CHOP + ASCT and R-HyperCVAD resulted in similar PFS (P =.66). R-HyperCVAD induction led to a higher incidence of toxicity, including therapy discontinuation and need for transfusions, compared with R-CHOP, although rates of adverse events were similar for R-HyperCVAD alone and R-CHOP + ASCT. Conclusion R-CHOP alone is less effective therapy for fit older patients with MCL. Intensifying therapy with R-HyperCVAD induction or ASCT consolidation after R-CHOP is associated with prolonged PFS and similar rates of toxicity. Consideration should be given to individual preferences regarding the differing method of administration and relative timing of toxicity with each regimen.

Original languageEnglish
Pages (from-to)92-97
Number of pages6
JournalClinical Lymphoma, Myeloma and Leukemia
Volume15
Issue number2
DOIs
StatePublished - Feb 1 2015

Keywords

  • Chemotherapy
  • Non-Hodgkin lymphoma
  • Survival
  • Toxicity
  • Treatment outcomes

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