Department of Internal Medicine, Division of Hematology
Contributions
Type: Publication Only
Background
Mantle cell lymphoma (MCL) is seen in predominantly elderly and male patients, and responsive to chemotherapy but usually remission periods are short. There is no standart treatment regimen but addition of rituximab to treatment protocols increased response rates. Bortezomib has been shown to have synergistic effect with rituximab and alternative combination regimens [eg. BORID (bortezomib-rituximab-dexamethasone)] have been implemented.
Aims
To evaluate the effect of BORID regimen to prognosis and survival in MCL.
Methods
We investigated 15 patients diagnosed MCL between 2001-2014 in our clinic and treated with BORID regimen during follow up because of relapsed disease. Demographic data collected from patient files retrospectively.
Results
73% of patients were male, and the median age was 65 years (range, 46-73 years). All of the patients were in advanced stage (III-IV) at diagnosis and according to MIPI score all patients were high risk. Mean hemoglobin level was 10.7 g/dL (range, 6.2-14.8 g/dL). Mean leukocyte and lymphocyte counts were 8.900 x 109/L (range, 2.79-561 x 109/L) and 2.2 x 109/L (0.7-522 x 109/L), respectively. LDH was normal in seven (47%) patients and high in 8. Ki-67 index was examined in 9 patients, and it was >%50 in 3. Median number of treatments prior to BORID was 2 (range, 1-5) and median BORID cycle was 3 (range, 1-6). Treatment regimens are listed in Table 1. BORID was discontinued after first cycle in 3 patients (20%) because of side effects; 1 patient had tumor lysis syndrome, 1 had elevated liver enzymes and 1 grade 4 polyneuropathy. Response rates for BORID were as follows: 1 patient was non-responsive and lost the follow-up after two cycles, 1 patient was partial responsive after 6 cycles and she received 12 courses of BORID totally, after all she had complete response. 1 patient lost the follow up after 3 cycles, 1 had tumour lysis syndrome and died after first course of BORID, 1 patient had progression and CNS involvement after 3 cycles, 1 patient had hepatotoxicity and lost the follow-up after first course, 2 patients had partial remission, 6 patients were non-responsive and one of them died because of pneumosepsis after second course of BORID, 1 patient had grade 4 polyneuropathy after first cycle but she remained progression free for 23 months. 4 patients received SCT (3 autologous, 1 autologous and allogeneic), and median survival was 41 months (range, 7-152 months).
Summary
Cure in MCL is not possible with current treatment strategies. Combination of bortezomib and rituximab may be appropriate treatment regimen in relapsed MCL especially for patients who are not candidate for SCT or with comorbidities, but to evaluate the efficacy and toxicity of BORID in relapsed MCL prospective studies are needed.
Keyword(s): Bortezomib, Mantle cell lymphoma, Relapsed lymphoma, Rituximab
Session topic: Publication Only
Type: Publication Only
Background
Mantle cell lymphoma (MCL) is seen in predominantly elderly and male patients, and responsive to chemotherapy but usually remission periods are short. There is no standart treatment regimen but addition of rituximab to treatment protocols increased response rates. Bortezomib has been shown to have synergistic effect with rituximab and alternative combination regimens [eg. BORID (bortezomib-rituximab-dexamethasone)] have been implemented.
Aims
To evaluate the effect of BORID regimen to prognosis and survival in MCL.
Methods
We investigated 15 patients diagnosed MCL between 2001-2014 in our clinic and treated with BORID regimen during follow up because of relapsed disease. Demographic data collected from patient files retrospectively.
Results
73% of patients were male, and the median age was 65 years (range, 46-73 years). All of the patients were in advanced stage (III-IV) at diagnosis and according to MIPI score all patients were high risk. Mean hemoglobin level was 10.7 g/dL (range, 6.2-14.8 g/dL). Mean leukocyte and lymphocyte counts were 8.900 x 109/L (range, 2.79-561 x 109/L) and 2.2 x 109/L (0.7-522 x 109/L), respectively. LDH was normal in seven (47%) patients and high in 8. Ki-67 index was examined in 9 patients, and it was >%50 in 3. Median number of treatments prior to BORID was 2 (range, 1-5) and median BORID cycle was 3 (range, 1-6). Treatment regimens are listed in Table 1. BORID was discontinued after first cycle in 3 patients (20%) because of side effects; 1 patient had tumor lysis syndrome, 1 had elevated liver enzymes and 1 grade 4 polyneuropathy. Response rates for BORID were as follows: 1 patient was non-responsive and lost the follow-up after two cycles, 1 patient was partial responsive after 6 cycles and she received 12 courses of BORID totally, after all she had complete response. 1 patient lost the follow up after 3 cycles, 1 had tumour lysis syndrome and died after first course of BORID, 1 patient had progression and CNS involvement after 3 cycles, 1 patient had hepatotoxicity and lost the follow-up after first course, 2 patients had partial remission, 6 patients were non-responsive and one of them died because of pneumosepsis after second course of BORID, 1 patient had grade 4 polyneuropathy after first cycle but she remained progression free for 23 months. 4 patients received SCT (3 autologous, 1 autologous and allogeneic), and median survival was 41 months (range, 7-152 months).
Summary
Cure in MCL is not possible with current treatment strategies. Combination of bortezomib and rituximab may be appropriate treatment regimen in relapsed MCL especially for patients who are not candidate for SCT or with comorbidities, but to evaluate the efficacy and toxicity of BORID in relapsed MCL prospective studies are needed.
Keyword(s): Bortezomib, Mantle cell lymphoma, Relapsed lymphoma, Rituximab
Session topic: Publication Only