Adding rituximab to the chemotherapies CHOP and DHAP before stem cell transplantation

This study examined the effectiveness of adding rituximab (Rituxan) to chemotherapy combinations. This study concluded that this combination was safe and effective in mantle cell lymphoma.

There is no standard treatment for newly diagnosed younger (less than 65) patients with mantle cell lymphoma. Cytarabine-based chemotherapy regimens have shown promising results. Rituximab is a treatment that binds to a protein on the cancer cell, leading to cell death. Treatment with rituximab alone has not improved outcomes. Rituximab combined with chemotherapy has been associated with improved survival.

Prior studies have noted the effectiveness of the chemotherapies CHOP followed by DHAP. CHOP is a combination of the chemotherapies cyclophosphamide, doxorubicin, vincristine, and prednisone. DHAP is a combination of the chemotherapies dexamethasone, cytarabine, and cisplatin. It is not clear whether adding rituximab to the CHOP/DHAP regimen would improve response.

This study included 60 patients. All patients were treated with CHOP plus rituximab (R-CHOP) followed by DHAP plus rituximab (R-DHAP). This was followed by stem cell (immature blood cell) transplantation in 53 patients. Patients were followed for an average of 67 months.

The response rate was 93% after R-CHOP and 95% after R-DHAP. 57% of patients were in complete response (no sign of active disease) after R-DHAP. Average 5-year overall survival (time from treatment until death from any cause) was 75%. Average time to disease progression was 84 months.

There were no unexpected side effects or deaths due to side effects. Eleven patients later developed second cancers. 

This study concluded that adding rituximab to CHOP/DHAP was safe and effective for younger patients with mantle cell lymphoma.