Fiche publication
Date publication
janvier 2013
Journal
Blood
Auteurs
Membres identifiés du Cancéropôle Est :
Dr CASASNOVAS Olivier
,
Pr DELMER Alain
Tous les auteurs :
Delarue R, Haioun C, Ribrag V, Brice P, Delmer A, Tilly H, Salles G, Van Hoof A, Casasnovas O, Brousse N, Lefrere F, Hermine O,
Lien Pubmed
Résumé
Treatment of mantle cell lymphoma (MCL) in younger patients remains a challenge. We report results of a phase 2 trial using cytarabine and rituximab as induction regimen before autologous stem cell transplantation. Patients younger than 66 years with stage 3 or 4 MCL were included. Treatment consisted of 3 courses of CHOP(21) with rituximab at the third one and 3 of R-DHAP. Responding patients were eligible for autologous stem cell transplantation with TAM6 or BEAM. Sixty patients were included. Median age was 57 years. Characteristics of patients were: BM involvement 85%, leukemic disease 48%, gastrointestinal involvement 52%, Performance Status > 16%, lactate dehydrogenase > 1N 38%, Mantle Cell Lymphoma International Prognostic Index (low 55%, intermediate 38%, high 13%). The overall response rate was 93% after (R)-CHOP and 95% after R-DHAP. Although uncommon after (R)-CHOP (12%), 57% of patients were in complete response after R-DHAP. With median follow-up of 67 months, median event-free survival is 83 months, and median overall survival is not reached. Five-year overall survival is 75%. Comparison with a previous study without rituximab shows improvement of outcome (median event-free survival, 51 vs 83 months). No toxic death or unexpected toxicities were observed. This study confirms that induction with rituximab and cytarabine-based regimens is safe and effective in MCL patients. This regimen is currently compared with R-CHOP(21) induction in a multicentric European protocol.
Mots clés
Adult, Aged, Antibodies, Monoclonal, Murine-Derived, administration & dosage, Antineoplastic Combined Chemotherapy Protocols, administration & dosage, Cisplatin, administration & dosage, Cyclophosphamide, administration & dosage, Cytarabine, administration & dosage, Dexamethasone, administration & dosage, Disease-Free Survival, Doxorubicin, administration & dosage, Female, Hematologic Diseases, chemically induced, Humans, Kaplan-Meier Estimate, Kidney Diseases, chemically induced, Lymphoma, Mantle-Cell, drug therapy, Male, Melphalan, administration & dosage, Middle Aged, Neoplasms, Second Primary, epidemiology, Peripheral Blood Stem Cell Transplantation, Prednisone, administration & dosage, Rituximab, Transplantation Conditioning, Transplantation, Autologous, Treatment Outcome, Vincristine, administration & dosage, Whole-Body Irradiation
Référence
Blood. 2013 Jan 3;121(1):48-53
