Journal
BRITISH JOURNAL OF HAEMATOLOGY
Volume 172, Issue 1, Pages 80-88Publisher
WILEY
DOI: 10.1111/bjh.13796
Keywords
mantle cell lymphoma; hyper-CVAD; methotrexate; treatment; secondary malignancy
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Funding
- NATIONAL CANCER INSTITUTE [P30CA016672, P30CA008748] Funding Source: NIH RePORTER
- NCI NIH HHS [P30 CA008748, P30 CA016672] Funding Source: Medline
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Intensive chemotherapy regimens containing cytarabine have substantially improved remission durability and overall survival in younger adults with mantle cell lymphoma (MCL). However, there have been no long-term follow-up results for patients treated with these regimens. We present long-term survival outcomes from a pivotal phase II trial of rituximab, hyper-fractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone alternating with methotrexate and cytarabine (R-HCVAD/MA). At 15 years of follow-up (median: 13.4 years), the median failure-free survival (FFS) and overall survival (OS) for all patients was 4.8 years and 10.7 years, respectively. The FFS seems to have plateaued after 10 years, with an estimated 15-year FFS of 30% in younger patients (<= 65 years). Patients who achieved complete response (CR) after 2 cycles had a favourable median FFS of 8.8 years. Six patients developed myelodysplastic syndrome/acute myeloid leukaemia (MDS/AML) whilst in first CR. The 10-year cumulative incidence of MDS/AML of patients in first remission was 6.2% (95% confidence interval: 2.5-12.2%). In patients with newly diagnosed MCL, R-HCVAD/MA showed sustained efficacy, with a median OS exceeding 10 years in all patients and freedom from disease recurrence of nearly 15 years in almost one-third of the younger patients (<= 65 years).
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