Alternating R-CHOP and R-cytarabine is a safe and effective regimen for transplant-ineligible patients with a newly diagnosed mantle cell lymphoma

Authors	KLENER Pavel FRONKOVA Eva BELADA David FORSTEROVA Kristina PYTLIK Robert KALINOVA Marketa SIMKOVIC Martin ŠÁLEK David MOCIKOVA Heidi PROCHAZKA Vít BLAHOVCOVA Petra JANÍKOVÁ Andrea MARKOVA Jana OBR Ales BERKOVA Adela KUBINYI Jozef VASKOVA Martina MEJSTRIKOVA Ester CAMPR Vít JAKSA Radek KODET Roman MICHALOVA Kyra TRKA Jan TRNENY Marek
Year of publication	2018
Type	Article in Periodical
Magazine / Source	Hematological Oncology
MU Faculty or unit	Faculty of Medicine
Citation
Doi	http://dx.doi.org/10.1002/hon.2483
Keywords	elderly patients; high-dose cytarabine; mantle cell lymphoma; PET-CT; rituximab maintenance
Description	Implementation of cytarabine into induction therapy became standard of care for younger patients with mantle cell lymphoma (MCL). On the basis of its beneficial impact, many centers incorporated cytarabine at lower doses also into first-line treatments of elderly patients. We conducted a multicenter observational study that prospectively analyzed safety and efficacy of alternating 3+3cycles of R-CHOP and R-cytarabine for newly diagnosed transplant-ineligible MCL patients. A total of 73 patients were enrolled with median age 70years. Most patients had intermediate (39.7%) and high-risk (50.7%) disease according to MCL international prognostic index. Rituximab maintenance was initiated in 58 patients. Overall response rate reached 89% by positron emission tomography-computed tomography, including 75.3% complete remissions. Two patients (2.7%) did not complete the induction therapy because of toxicity. Three patients (4.1%) were considered nonresponders, which led to therapy change before completion of induction. Estimated progression-free survival and overall survival were 51.3% and 68.6% at 4years, respectively. Mantle cell lymphoma international prognostic index, bulky disease ( 5cm), and achievement of positron emission tomography-negativity independently correlated with progression-free survival. Grade 3 to 4 hematologic and nonhematologic toxicity was documented in 48% and 20.5% patients, respectively. Alternation of R-CHOP and R-cytarabine represents feasible and very effective regimen for elderly/comorbid MCL patients. This study was registered at GovTrial () NCT03054883.