Abstract
Introduction: Mantle cell lymphoma (MCL) is an incurable subtype of B-NHL. Implementation of high-dose cytarabine (HDAC) into induction followed by high-dose therapy and stem-cell transplantation (HDT-SCT) and rituximab maintenance (RM) became standard of care for the younger patients with newly dg. MCL. Methods: We retrospectively analyzed data of 148 pts with newly dg. MCL from the Czech Lymphoma Study Group Registry. The pts were treated with the Nordic protocol (Geisler et al. Blood, 2008) in 3 hematology centers in the Czech Republic since 1.1.2006 until 31.1.2015. Consolidation with HDT-SCT was carried out in most pts, who achieved response after induction. Administration of RM every 2-3 months, usually for the total of 8-12 doses, depended on the practice of the particular center. Results: Median age was 57 years (men : women = 2:1). MIPI low, intermediate, and high risk was observed in 59 (40.4%), 56 (38.4%), and 31 (21.2%) pts, resp. Bone marrow involvement was found in 78.4% pts, splenomegaly in 53.8% pts, extranodal (EN) involvement in 52.8%, bulky disease ≥10 cm in 16.3%. Out of 91 analyzed biopsies 44% revealed high proliferation index by Ki-67 (≥ 30%). Two pts died during induction from septic shock. Therapy was changed in 3 pts because of insufficient response after 3 cycles, and 143 pts (96.6%) completed the induction. ASCT with BEAM was performed in 125 pts (87.4%). Two pts died from septic shock during HDT-SCT. In the subgroup of 139 pts, who were evaluated by CT after induction (and before HDT-SCT) the ORR was 100% (74.8% CR, 25.2% PR). By March 1, 2017, the median follow-up of the living pts was 4 years. At that time, 41 out of 148 (27.8%) analyzed pts experienced disease relapse, and 32 pts (21.6%) had died (8 in remission). Median PFS and OS of the total cohort reached 6.7 and 10.9 years, respectively. Out of the 141 pts, who completed induction (with or without ASCT), 2 pts progressed before the first scheduled dose of RM could be given (≤ 3 months after end of the induction/ASCT), 72 pts received RM, and 67 pts were observed only. RM vs observation (no RM) led to improvement of PFS-M (PFS since the last treatment) at 4 years 80.1% versus 61.2% (HR 0.43; CI 95% 0.24-0.82, p 0.011) and OS-M at 4 years 92.3% versus 75.2% (HR 0.42; CI 95% 0.19-0.98; p 0.05) (see Figure). Rituximab maintenance led to 57% risk reduction of progression and 58% risk reduction of death. Conclusion: Nordic protocol represents safe and very effective regimen for younger MCL patients. The analysis confirmed significant impact of rituximab maintenance on prolonged survival with 58% risk reduction of death. Keywords: Ara-C; mantle cell lymphoma (MCL); rituximab
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
