Source: Blood  |  Posted 9 years ago

Standard-dose debulking chemotherapy followed by a high-dose rituximab-supplemented sequence may lead to long-term event-free survival and overall survival rates in mantle-cell lymphoma, say researchers.

The investigators, from nine Italian haematological departments, studied 28 previously untreated patients with advanced-stage mantle-cell lymphoma. The patients were given three cycles of standard-dose debulking chemotherapy, followed by a high-dose rituximab-supplemented sequence, which included intravenous administration of high doses of cyclophosphamide, cytarabine, melphalan and mitoxantrone plus melphalan.

Study endpoints included toxicity, clinical and molecular response rates, long-term event-free survival and overall survival rates, as well as the ability to harvest tumour-free peripheral blood stem cells.

Optimal amounts of polymerase chain reaction-negative CD34+ cells were collected from 20 patients.

One patient died from toxicity, leaving 27 patients assessable for response. Of the 27 who achieved a complete response, 24 remained in continuous complete remission after a median follow-up of 35 months.

Three patients had transient evidence of disease detectable in the bone marrow by polymerase chain reaction.

Results showed that survival rates at 54 months were, at 89%, more than double those in 35 age-matched historical controls (42%) after high-dose sequential chemotherapy and []in vivo[] rituximab-purged stem cell autografting.

Improvement in event free-survival was even more marked. After the high-dose chemotherapy and cell autografting, the event-free survival was 79%, more than quadruple the 18% in controls.