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Annals of Oncology Advance Access originally published online on June 9, 2006
Annals of Oncology 2006 17(9):1418-1423; doi:10.1093/annonc/mdl127
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© 2006 European Society for Medical Oncology

hematologic malignancies

Maintenance rituximab following induction chemoimmunotherapy may prolong progression-free survival in mantle cell lymphoma: a pilot study from the Wisconsin Oncology Network

BS Kahl1,*, WL Longo1, JC Eickhoff2, J Zehnder3, C Jones3, J Blank4, T McFarland5, W Bottner6, H Rezazedeh7, J Werndli1 and HH Bailey1

1 Department of Medicine, University of Wisconsin, Madison, WI
2 Department of Statistics and Bioinformatics, University of Wisconsin, Madison, WI
3 Department of Pathology, Stanford University, Palo Alto, CA
4 Green Bay Oncology, Green Bay, WI
5 UW Health Hematology/Oncology, Madison, WI
6 Gundersen Lutheran Medical Center, LaCrosse, WI
7 Aspirus Cancer Center, Wausau, WI, USA

*Correspondence to: Dr B. Kahl, University Hospital, 600 Highland Ave, H4/534 CSC, Madison, WI 53792, USA. Tel: +1-608-263-1836; Fax: +1-608-262-1982; E-mail: bsk{at}medicine.wisc.edu

Background: There is no standard first line treatment for mantle cell lymphoma.

Patients and methods: This was a multicenter phase II pilot study of rituximab and modified hyper-fractionated cyclophosphamide, vincristine doxorubicin, dexamethasone (modified R-hyperCVAD) administered every 28 days for four to six cycles followed by rituximab maintenance therapy consisting of four weekly doses every 6 months for 2 years. Unlike traditional hyperCVAD regimens, no methotrexate or cytarabine was administered.

Results: Of 22 patients, the overall response rate was 77% and the complete response rate was 64%. With a median follow-up time of 37 months in surviving patients, the median PFS was 37 months and the median OS was not reached. The achievement of a molecular remission did not correlate with improved outcome. The major toxicity was expected myelosuppression. Two patients died during induction treatment. There were no major adverse effects during maintenance therapy.

Conclusion: In a multicenter trial, modified R-hyperCVAD was tolerable and effective induction therapy for untreated MCL. Maintenance rituximab appeared to prolong PFS without increasing toxicity.

Key words: mantle cell lymphoma, chemotherapy, biologic therapy


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