Blood Journal
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Comparative outcome of initial therapy for younger patients with mantle cell lymphoma: an analysis from the NCCN NHL Database

  1. Ann S. LaCasce1,
  2. Jonathan L. Vandergrift2,
  3. Maria A. Rodriguez3,
  4. Gregory A. Abel1,
  5. Allison L. Crosby1,
  6. Myron S. Czuczman4,
  7. Auayporn P. Nademanee5,
  8. Douglas W. Blayney6,
  9. Leo I. Gordon7,
  10. Michael Millenson8,
  11. Ann Vanderplas5,
  12. Eva M. Lepisto2,
  13. Andrew D. Zelenetz9,
  14. Joyce Niland5, and
  15. Jonathan W. Friedberg10
  1. 1Medical Oncology, Dana-Farber Cancer Institute, Boston, MA;
  2. 2National Comprehensive Cancer Network, Fort Washington, PA;
  3. 3Lymphoma and Myeloma, MD Anderson Cancer Center, Houston, TX;
  4. 4Medical Oncology and Immunology, Roswell Park Cancer Institute, Buffalo, NY;
  5. 5City of Hope National Medical Center, Duarte, CA;
  6. 6Stanford Cancer Center, Stanford, CA;
  7. 7Department of Medicine, Division of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL;
  8. 8Fox Chase Cancer Center, Philadelphia, PA;
  9. 9Memorial Sloan-Kettering Cancer Center, New York, NY; and
  10. 10James P. Wilmot Cancer Center, University of Rochester, Rochester, NY
  1. Presented in abstract form at the 2009 American Society of Hematology annual meeting, December 5-8, New Orleans, LA.

Abstract

Few randomized trials have compared therapies in mantle cell lymphoma (MCL), and the role of aggressive induction is unclear. The National Comprehensive Cancer Network (NCCN) Non-Hodgkin Lymphoma (NHL) Database, a prospective cohort study collecting clinical, treatment, and outcome data at 7 NCCN centers, provides a unique opportunity to compare the effectiveness of initial therapies in MCL. Patients younger than 65 diagnosed between 2000 and 2008 were included if they received RHCVAD (rituximab fractionated cyclophosphamide, vincristine, adriamycin, and dexamethasone), RCHOP+HDT/ASCR (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone + high-dose therapy/autologous stem cell rescue), RHCVAD+HDT/ASCR, or RCHOP. Clinical parameters were similar for patients treated with RHCVAD (n = 83, 50%), RCHOP+HDT/ASCR (n = 34, 20%), RCHOP (n = 29, 17%), or RHCVAD+HDT/ASCR (n = 21, 13%). Overall, 70 (42%) of the 167 patients progressed and 25 (15%) expired with a median follow-up of 33 months. There was no difference in progression-free survival (PFS) between aggressive regimens (P > .57), which all demonstrated superior PFS compared with RCHOP (P < .004). There was no difference in overall survival (OS) between the RHCVAD and RCHOP+HDT/ASCR (P = .98). RCHOP was inferior to RHCVAD and RCHOP+HDT/ASCR, which had similar PFS and OS. Despite aggressive regimens, the median PFS was 3 to 4 years. Future trials should focus on novel agents rather than comparing current approaches.

  • Submitted July 27, 2011.
  • Accepted December 31, 2011.
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