Salvage gemcitabine and oxaliplatin with Rituxan for mantle lymphoma – pro

Mantle cell lymphoma is a fairly recently identified subtype of non-Hodgkin’s lymphoma. Regarded as a low-grade tumour in previous classifications, it has a median survival of only 36 months and is incurable by current treatment approaches. Widespread disease is usually present at diagnosis involving lymph nodes, spleen, bone marrow and extranodal sites such as the gastrointestinal tract. Initial response rates to treatment are high but the majority of patients relapse within 2 years. There is some evidence that high dose myeloablative chemotherapy and total body irradiation followed by stem cell rescue in first remission may give long-term disease-free survival. Both rituximab and Velcade are being clinically investigated as a part of induction. A recent study that used Rituxan reported good results in comparison with historical controls.

Rituximab, gemcitabine and oxaliplatin are active as single agents in relapsed or refractory lymphoma. In a recent study of the combination of the three drugs, forty-six patients with relapsed or refractory B-cell lymphoma received up to eight cycles of R-GemOx (rituximab 375 mg/m2 on day 1, gemcitabine 1000 mg/m2 and oxaliplatin 100 mg/m2 on day 2). The majority (72%) had diffuse large B-cell lymphoma. High CR/CRu rates were observed in all histological subtypes. In patients who had previously received rituximab, the CR/CRu rate after eight cycles was 65%. The 2-year event-free and overall survival rates (median follow-up of 28 months) were 43% and 66%, respectively. Among responders, the probability of being disease free for 2 years was 62%. Treatment was generally well tolerated. The treatmetn is still udner study: Rituximab, Gemcitabine and Oxaliplatin (R-GEMOX)for Refractory/Relapsed B-Cell Lymphoma, NCT00169195

Imrie K, Stevens A, Meyer R, Hematology Disease Site Group. Rituximab in lymphoma and chronic lymphocytic leukemia: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2005 Dec 22. 46 p. (Evidence-based series; no. 6-8). [65 references]

El Gnaoui , J Dupuis , K Belhadj , J-P Jais , A Rahmouni , C Copie-Bergman , I Gaillard , M Diviné , I Tabah-Fisch , F Reyes , and C Haioun Rituximab, gemcitabine and oxaliplatin: an effective salvage regimen for patients with relapsed or refractory B-cell lymphoma not candidates for high-dose therapy Annals of Oncology. Ann Oncol 18: 1363-1368.

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