Effectiveness of bortezomib, cladribine, and rituximab in mantle cell and follicular lymphomas

This study examined the combination of bortezomib (Velcade), cladribine (Leustatin), and rituximab (Rituxan) for patients with mantle cell or follicular lymphoma. The authors concluded that this combination was effective and can be an alternative for patients who cannot undergo stem cell transplantation.

There is no standard of care treatment option for mantle cell lymphoma (MCL). First treatment options generally include combinations of chemotherapies and rituximab, such as R-CHOP (rituximab, dexamethasone, cytarabine, and prednisone). Patients with relapsed or refractory (did not respond to treatment) MCL often undergo high-dose chemotherapy followed by stem cell transplantation. Patients with follicular lymphoma (FL) are often treated with chemotherapy combined with rituximab. These treatments, however, are associated with many side effects.

Bortezomib is a treatment that blocks proteasomes, molecules involved in cancer growth. It has been useful in relapsed/refractory MCL and FL. Cladribine is a treatment that leads to cancer cell death. It has been shown to be effective in other forms of NHL. It is not clear whether these treatments, combined with rituximab, would be effective as a first-line treatment or in relapsed/refractory MCL and FL.

This study included 24 patients. 46% of these patients had MCL and 20.8% had FL. The remaining 33.2% had other forms of lymphoma. Patients were treated with up to 6 cycles of a bortezomib, cladribine, and rituximab combination. Patients were followed for an average of 38.5 months.

Overall, 92% of patients showed a response to treatment.  The average 2-year progression-free survival (PFS, time from treatment until disease progression) was 82% for MCL patients and 54% for patients with FL and other forms of lymphoma. The average 2-year PFS was 80% for patients treated for the first time, and 57% for patients with relapsed/refractory disease.

The most common severe side effects were low white blood cell levels (33%), low platelets (25%, blood cells involved in clotting) and fatigue (21%). 79% of patients experienced some degree of fatigue. Other non-severe side effects included constipation (67%), nausea (63%), cough (46%), and rash (42%). 25% experienced neuropathy (nerve damage).

This study concluded that the combination of bortezomib, cladribine, and rituximab was effective and safe (but with side effects) in patients with MCL and FL.