Front-line treatments for elderly patients with mantle cell lymphoma

This article reviewed the front-line treatment options for elderly (65 years or older) patients with mantle cell lymphoma.

For older patients with mantle cell lymphoma, the goals of front-line treatment vary. More intense treatments such as chemotherapy can help achieve remission and improve survival. However, frail patients may not be able to tolerate the side effects of intense treatment. For these patients, disease control and reducing side effects are the main goals.

RHCVAD (rituximab, cyclophosphamide, vincristine, doxorubicin, dexamethasone) has been used in older patients with untreated mantle cell lymphoma. In one study of 25 fit older patients, 68% achieved complete remission. Three-year overall survival (patients still alive 3 years later) was 75%. However, life-threatening low platelet count (75%) and white blood cell count (89%) were reported.

Stem cell transplantation (ASCT) is another option. In one study of 712 patients, 11.1% were older than 65. Five-year overall survival was 61% (older patients) and 67% (younger patients). Five-year progression-free survival (patients alive without a return of disease) was 29% (older patients) and 40% (younger patients). In another study of 38 patients who received ASCT after intense chemotherapy, all patients achieved complete remission. 57% of patients had disease progression after a follow-up of 2.7 years. The average overall survival was 6 years.

BR (bendamustine, rituximab) has become a standard first-line regimen. In one study with 20 fit older patients, BR was combined with low-dose cytarabine (Ara-C). 91% of patients achieved complete remission. Two-year progression-free survival was 81%. In another study comparing BR to standard chemotherapy, patients who were less fit (those who may have other conditions) and treated with BR were 1.95 times more likely to achieve complete remission. Progression-free survival was also significantly improved. Additional drugs combined with the BR regimen remain under investigation.

Other options for less fit MCL patients included modified (less intense) versions of chemotherapy regimens, such as RHCVAD.

For frail patients, lenalidomide (Revlimid) plus rituximab is one option. In one study with 38 patients, 92% of patients responded to treatment. 64% of patients achieved complete remission. Two-year overall survival was 97%. Two-year progression-free survival was 85%.

This article reviewed the front-line treatment options for elderly patients with mantle cell lymphoma. These included chemotherapy, stem cell transplantation, and immunotherapy.

Some of the studies reviewed here had small patient populations or short follow-up periods.