Intense chemo wards off recurrence in half of mantle cell lymphoma patients after seven years

More than half of younger mantle cell lymphoma patients who received an intensive regimen of chemotherapy as frontline treatment remain in remission seven years later, researchers at The University of Texas M. D. Anderson Cancer Center report today at the 50th annual meeting of the American Society of Hematology.

Among patients 65 or younger, 52 percent survived without disease recurrence at a median of seven years of follow-up, said first author Jorge Romaguera, M.D., professor in M. D. Anderson's Department of Lymphoma and Myeloma. Overall survival for this subgroup was 68 percent.

"There is some disagreement about whether these younger patients should receive a bone marrow transplant as frontline therapy rather than chemotherapy," Romaguera said. "Our results with chemotherapy are as good as any transplant data. We don't believe a transplant is necessary as a first treatment in newly diagnosed mantle cell lymphoma."

Mantle cell lymphoma is one of the most lethal versions of non-Hodgkin lymphoma. Romaguera and colleagues have followed 97 patients for up to nine years who received rituximab plus a combination of chemotherapies known as hyperCVAD, alternated with rituximab plus high-dose methotrexate/cytarabine in 6-8 cycles.

Out of those patients, 87 percent achieved either a complete response or unconfirmed complete response after six cycles. Of 65 patients who were 65 or younger, 30 relapsed. Of 32 patients older than 65, a total of 23 relapsed.

Overall survival for the entire group, including all ages up to 80 years, was 60 percent; 43 percent were at failure-free survival, with no recurrence of the disease, at seven years of median follow-up.

Survival is about the same for patients who undergo stem cell transplantation, Romaguera said. No randomized studies between the chemotherapy regimen, stem cell transplants or the chemotherapy plus stem cell transplant have been done.

About 3,500 new cases of mantle cell lymphoma are diagnosed in the United States annually. The average age of diagnosis is the mid-sixties and median survival is about four years.