Abstract
Intensive chemotherapy regimens are not feasible in many adults with mantle cell lymphoma (MCL). We sought to build upon our previous experience with a non-intensive regimen, modified R-hyperCVAD chemotherapy (rituximab, cyclophosphamide, vincristine, doxorubicin, dexamethasone) with maintenance rituximab (MR), by the incorporation of bortezomib (VcR-CVAD) and the extension of MR beyond 2 years. Patients with previously untreated MCL received VcR-CVAD chemotherapy every 21 d for six cycles. Patients achieving at least a partial response to induction chemotherapy received rituximab consolidation (375 mg/m(2) × 4 weekly doses) and MR (375 mg/m(2) every 12 weeks × 20 doses). The primary end points were overall and complete response (CR), and secondary endpoints were progression-free (PFS) and overall survival (OS). Thirty patients were enrolled, with a median age of 61 years. All patients had advanced stage disease, and 60% had medium/high MCL International Prognostic Index risk factors. A CR or unconfirmed CR was achieved in 77% of patients. After a median follow-up of 42 months, the 3-year PFS and OS were 63% and 86%, respectively. The observed 3-year PFS and OS with VcR-CVAD in MCL were comparable to reported outcomes with more intensive regimens. A cooperative group trial (E1405) is attempting to replicate these promising results.
© 2011 Blackwell Publishing Ltd.
Publication types
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Clinical Trial
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Multicenter Study
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Research Support, N.I.H., Extramural
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Research Support, Non-U.S. Gov't
MeSH terms
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Aged
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Antibodies, Monoclonal, Murine-Derived / administration & dosage
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Antibodies, Monoclonal, Murine-Derived / adverse effects
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Antineoplastic Combined Chemotherapy Protocols / administration & dosage
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Antineoplastic Combined Chemotherapy Protocols / adverse effects
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Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
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Boronic Acids / administration & dosage
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Boronic Acids / adverse effects
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Bortezomib
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Cyclophosphamide / administration & dosage
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Cyclophosphamide / adverse effects
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Dexamethasone / administration & dosage
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Dexamethasone / adverse effects
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Disease-Free Survival
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Doxorubicin / administration & dosage
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Doxorubicin / adverse effects
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Female
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Granulocyte Colony-Stimulating Factor / therapeutic use
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Hematologic Diseases / chemically induced
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Humans
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Kaplan-Meier Estimate
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Lymphoma, Mantle-Cell / drug therapy*
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Male
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Middle Aged
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Peripheral Nervous System Diseases / chemically induced
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Proportional Hazards Models
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Protease Inhibitors / administration & dosage
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Protease Inhibitors / adverse effects
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Protease Inhibitors / pharmacology
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Pyrazines / administration & dosage
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Pyrazines / adverse effects
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Remission Induction
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Rituximab
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Treatment Outcome
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Vincristine / administration & dosage
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Vincristine / adverse effects
Substances
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Antibodies, Monoclonal, Murine-Derived
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Boronic Acids
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Protease Inhibitors
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Pyrazines
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Granulocyte Colony-Stimulating Factor
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Rituximab
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Vincristine
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Bortezomib
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Dexamethasone
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Doxorubicin
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Cyclophosphamide