Cancer Treatment Today

This regimen is typically used for ALL or Burkitt’s lymphoma. Standard doxorubicin-based combination chemotherapy, such as CHOP, frequently induces remissions of short duration in these agressive conditions. Outcome in comparative studies is significantly superior with Hyper-CVAD therapy compared with the VAD regimens, in terms of both CR rate and long-term prognosis.

For mantle histology, arguably also an agressive lymphoma, but a quite different one at that, there are only scattered and preliminary reports of Hyper-CVAD use. Single-center studies with R-Hyper-CVAD and/or autologous stem-cell transplant (ASCT) have produced 3-year OS rates >80%, prompting many to adopt their use. Others question these high rates.

The NCCN 2011 also recommends autologous transplantation after Hyper-CVAD but it does not recommend it after a complete response and after a partial response it recommends on p. MANT-@ a clinical trial, including of autologous or allogeneic transplantation. Curiously on the next page is appears to recommend autologosu or allogeneic transplantation and does not mention a clinical trial. This is corroborated on P. MS-82. I read this as a recommendation for an autologous or allogeneic transplant as consolidation for any responsive mantle cell lymphoma.

At a recent 2011 meeting of European Soceity of Oncology, a study was presented that Rituximab more than doubled the duration of remission in elderly patients with mantle cell lymphoma when used as maintenance therapy in those who had already responded to induction therapy in a large, randomized controlled trial.

First results from the European Mantle Cell Lymphoma (MCL) Network study show that rituximab maintenance is associated with a median remission of 77 months. In comparison, when interferon (IFN) was used as maintenance, the median was 24 months (hazard ratio, 0.54; P = .0109).

Overall survival data are not yet fully mature but suggest that rituximab (Rituxan in the United States, Mabthera in Europe) improves upon the rates achievable. At 4 years’ follow-up, 62% of patients treated with IFN and 77% of those maintained on rituximab were still alive. This difference was not statistically significant, however.

Rituximab is not licensed for the treatment of MCL in Europe or the United States.

This is too preliminary and needs to be published and peer-reviewed before changing standard of care.

Kluin Nelemans H, Zagonel V, Anastasopoulou A et al. Standard chemotherapy with or without high-dose chemotherapy for aggressive non-Hodgkin’s lymphoma: randomized phase III EORTC study. J Natl Cancer Inst 2001; 93: 22–30

B. S. Kahl, C. Peterson, J. Blank, T. McFarland, M. Huie, J. Eickhoff, J. Werndli, N. Callander, T. Myers A feasibility study of VcR-CVAD with maintenance rituximab for untreated mantle cell lymphomaJournal of Clinical Oncology, 2007 ASCO Annual Meeting Proceedings Part I. Vol 25, No. 18S (June 20 Supplement), 2007: 8062

M. Dreyling, Hyper-CVAD in mantle-cell lymphoma: Really “hyper” or just hype?
Leukemia and Lymphoma, Volume 49, Issue 6 June 2008 , pages 1017 – 1018