Treatment of older mantle cell lymphoma patients

This study compared treatments for older patients with mantle cell lymphoma (MCL). This study concluded that treatment with the combination R-CHOP followed by long-term rituximab (Rituxan) treatment was an effective option.

The average age at diagnosis for MCL is 65 years. Patients often have extensive disease at diagnosis, and are hard to treat. Standard treatment had been the chemotherapy combination CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), but complete remission (no sign of active disease) rates were low, and progression rates were high. New treatment options for both initial and long-term (maintenance) therapy are needed.

Fludarabine is a chemotherapy agent that was found in a previous study to be effective in combination with cyclophosphamide and rituximab (R-FC). Maintenance therapy with interferon has been considered standard by some trials. Rituximab has also been found to be effective. It is not clear which treatment option is most beneficial.

This study included 485 patients over the age of 60 with newly diagnosed MCL. 239 patients were randomly assigned to treatment with R-CHOP (CHOP plus rituximab). 246 patients were assigned to treatment with R-FC. The 316 patients who responded to treatment were randomly assigned to maintenance with rituximab (143) or interferon (131). Patients were followed for an average of 36 months after treatment.

Complete remission rates were not significantly different between R-FC (40%) and R-CHOP (34%). Progression rates were higher with R-FC (14%) compared to R-CHOP (5%). Four-year overall survival (time from treatment until death from any cause) was significantly lower with R-FC (47%) compared to R-CHOP (62%). Blood toxicities were more common with R-FC. Constipation and nerve pain were more common with R-CHOP.

Patients treated with rituximab for maintenance had a 45% reduction in the risk of progression or death compared to those treated with interferon. After 4 years, 58% of the rituximab group were still in remission, compared to 29% of the interferon group. Rituximab was more effective in patients treated with R-CHOP than R-FC. Of patients who responded to R-CHOP, 87% were still alive at 4 years with rituximab maintenance therapy, compared to 63% with interferon. Interferon was associated with more blood toxicity and fatigue. Rituximab was associated with more infections.

This study concluded that R-CHOP with rituximab maintenance therapy is effective for older MCL patients.