Contributions
Abstract: PB1776
Type: Publication Only
Background
In fit patients with mantle cell lymphoma (MCL), intensive chemotherapy containing rituximab (R) and cytarabine (Ara-C) followed by autologous stem cell transplantation (ASCT) is the backbone for treatment. Despite new data on novel induction schemes, reports on R-HCVAD/MTX-Ara-C (R-hyperfractionated-cyclophosphamide-doxorubicin-vincristine-dexamethasone and R-methotrexate-Ara-C) are lacking.
Aims
To analyze the outcome of MCL patients treated with R-HCVAD/MTX-Ara-C followed by ASCT.
Methods
From 2005 to 2017, data on MCL patients treated with R-HCVAD/MTX-Ara-C (3+3 cycles) followed by BEAM (BCNU, Etoposide, Ara-C, Melphalan) and ASCT was retrospectively analyzed. Five-year survival (5y-OS) and progression free survival (5y-PFS) from time of ASCT was calculated.
Results
A total of 28 patients (6 were external referrals) received induction with R-HCVAD/MTX-Ara-C. Median age was 60 years (interval 42-68) and 71% were male. At diagnosis, 96% had Ann-Arbor stage IV, 50% had B symptoms, 93% had ECOG performance status <2, 39% had increased lactic dehydrogenase, 57% had leukemic expression and 32% gastrointestinal invasion. MIPI was low-risk (LR) in 39%, intermediate-risk (IR) in 25% and high-risk (HR) in 36%.
For the 22 patients treated in our institution, overall response rate was 86% with complete response (CR) rate of 64%. Three patients died due to disease progression (2 during treatment) and 1 patient was ineligible for ASCT because of cardiovascular toxicity. The 6 patients externally referred to ASCT were all in CR.
Of the 24 patients who were submitted to ASCT the median age at transplantation was 60 years (17% had >65 years) and MIPI was LR in 46%, IR in 25% and HR in 29%. All patients made successful peripheral blood stem cell progenitors (PBSCP) harvest, 71% at the secondo R-MTX-Ara-C and the remaining in following cycles. Only 2 patients required plerixafor in addition to G-CSF. Median harvest for infusion was 2.90x10^9 CD34+ cells per kilogram (interval 2.08-7.70), with no differences between harvesting at the second R-MTX-Ara-C or after (p=0.260). There was no mortality associated with BEAM conditioning and ASCT. All engraftments were successful, with median time to neutrophil recovery of 11 days (interval 9-14) and to platelet recovery of 17 days (interval 12-42).
At the time of analysis, data was available on 22 patients (2 have yet to reach 100 days after ASCT). CR rate at +100 day was 100%, with 63% 5y-PFS and 77% 5y-OS after ASCT. Five patients relapsed and 4 deaths occurred (2 from lymphoma relapse and 2 due to secondary solid malignancies). Patients with HR MIPI had worst outcomes (median OS HR 58 months versus LR/IR not reached, p=0.007). Patients older than 60 years had inferior 5y-PFS (35% [median 59 months] for >60 years versus 82% for ≤60 years, p=0.022) but similar 5y-OS (57% vs 90%, p=0.060).
Conclusion
Even in an older and higher risk patient cohort, our results show similar outcomes to other induction schemes. R-HCVAD/MTX-Ara-C followed by ASCT remains a practical option for fit MCL patients.
Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): Autologous hematopoietic stem cell transplantation, Hyper-CVAD, Mantle cell lymphoma, Rituximab
Abstract: PB1776
Type: Publication Only
Background
In fit patients with mantle cell lymphoma (MCL), intensive chemotherapy containing rituximab (R) and cytarabine (Ara-C) followed by autologous stem cell transplantation (ASCT) is the backbone for treatment. Despite new data on novel induction schemes, reports on R-HCVAD/MTX-Ara-C (R-hyperfractionated-cyclophosphamide-doxorubicin-vincristine-dexamethasone and R-methotrexate-Ara-C) are lacking.
Aims
To analyze the outcome of MCL patients treated with R-HCVAD/MTX-Ara-C followed by ASCT.
Methods
From 2005 to 2017, data on MCL patients treated with R-HCVAD/MTX-Ara-C (3+3 cycles) followed by BEAM (BCNU, Etoposide, Ara-C, Melphalan) and ASCT was retrospectively analyzed. Five-year survival (5y-OS) and progression free survival (5y-PFS) from time of ASCT was calculated.
Results
A total of 28 patients (6 were external referrals) received induction with R-HCVAD/MTX-Ara-C. Median age was 60 years (interval 42-68) and 71% were male. At diagnosis, 96% had Ann-Arbor stage IV, 50% had B symptoms, 93% had ECOG performance status <2, 39% had increased lactic dehydrogenase, 57% had leukemic expression and 32% gastrointestinal invasion. MIPI was low-risk (LR) in 39%, intermediate-risk (IR) in 25% and high-risk (HR) in 36%.
For the 22 patients treated in our institution, overall response rate was 86% with complete response (CR) rate of 64%. Three patients died due to disease progression (2 during treatment) and 1 patient was ineligible for ASCT because of cardiovascular toxicity. The 6 patients externally referred to ASCT were all in CR.
Of the 24 patients who were submitted to ASCT the median age at transplantation was 60 years (17% had >65 years) and MIPI was LR in 46%, IR in 25% and HR in 29%. All patients made successful peripheral blood stem cell progenitors (PBSCP) harvest, 71% at the secondo R-MTX-Ara-C and the remaining in following cycles. Only 2 patients required plerixafor in addition to G-CSF. Median harvest for infusion was 2.90x10^9 CD34+ cells per kilogram (interval 2.08-7.70), with no differences between harvesting at the second R-MTX-Ara-C or after (p=0.260). There was no mortality associated with BEAM conditioning and ASCT. All engraftments were successful, with median time to neutrophil recovery of 11 days (interval 9-14) and to platelet recovery of 17 days (interval 12-42).
At the time of analysis, data was available on 22 patients (2 have yet to reach 100 days after ASCT). CR rate at +100 day was 100%, with 63% 5y-PFS and 77% 5y-OS after ASCT. Five patients relapsed and 4 deaths occurred (2 from lymphoma relapse and 2 due to secondary solid malignancies). Patients with HR MIPI had worst outcomes (median OS HR 58 months versus LR/IR not reached, p=0.007). Patients older than 60 years had inferior 5y-PFS (35% [median 59 months] for >60 years versus 82% for ≤60 years, p=0.022) but similar 5y-OS (57% vs 90%, p=0.060).
Conclusion
Even in an older and higher risk patient cohort, our results show similar outcomes to other induction schemes. R-HCVAD/MTX-Ara-C followed by ASCT remains a practical option for fit MCL patients.
Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): Autologous hematopoietic stem cell transplantation, Hyper-CVAD, Mantle cell lymphoma, Rituximab