Cytarabine-based induction immunochemotherapy in the front-line treatment of older patients with mantle cell lymphoma.

Autor: Ratnasingam S; Department of Haematology, Monash Health, Melbourne, Australia.; Department of Haematology, Andrew Love Cancer Centre, University Hospital Geelong, Geelong, Australia., Casan J; Department of Haematology, Monash Health, Melbourne, Australia. Joshua.casan@monashhealth.org.; School of Clinical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia. Joshua.casan@monashhealth.org., Shortt J; Department of Haematology, Monash Health, Melbourne, Australia.; School of Clinical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia., Hawkes E; Department of Medical Oncology and Clinical Haematology, Olivia Newton John Cancer and Wellness Centre, Austin Hospital, Melbourne, Australia.; Department of Medical Oncology, Eastern Health, Melbourne, Australia., Gilbertson M; Department of Haematology, Monash Health, Melbourne, Australia., McQuilten Z; Department of Haematology, Monash Health, Melbourne, Australia., Grigoriadis G; Department of Haematology, Monash Health, Melbourne, Australia.; Department of Haematology, Alfred Health, Melbourne, Australia.; School of Clinical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia., Htun KT; Department of Haematology, Alfred Health, Melbourne, Australia., Htet SM; Department of Haematology, Andrew Love Cancer Centre, University Hospital Geelong, Geelong, Australia., Campbell P; Department of Haematology, Andrew Love Cancer Centre, University Hospital Geelong, Geelong, Australia., Chai KL; Department of Haematology, St Vincent's Hospital, Melbourne, Australia., Quach H; Department of Haematology, St Vincent's Hospital, Melbourne, Australia., Patil S; Department of Haematology, Alfred Health, Melbourne, Australia., Opat S; Department of Haematology, Monash Health, Melbourne, Australia.; School of Clinical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia.
Jazyk: angličtina
Zdroj: Scientific reports [Sci Rep] 2019 Sep 19; Vol. 9 (1), pp. 13544. Date of Electronic Publication: 2019 Sep 19.
DOI: 10.1038/s41598-019-49776-9
Abstrakt: The role of cytarabine-based induction and autologous stem cell transplantation (ASCT) in front-line treatment of younger patients with mantle cell lymphoma (MCL) is well established, however the utility of intensive approaches in older patients remains unclear. This retrospective study compared first line treatment outcomes in patients aged 60 years or more, treated at six tertiary centres between 2000-2015. 70 patients included had a median age of 69 (60-91) and most (94%) demonstrated advanced stage disease. Treatment regimens included: R-CHOP-like (n = 39), alternating R-CHOP/R-DHAC (n = 10), R-HyperCVAD/R-MA (n = 7), R-CHOP/Cytarabine (Nordic Protocol) (n = 10) and other (n = 4). 16 patients underwent an ASCT. The median follow-up for surviving patients was 37 months. Compared to R-CHOP-like therapies, cytarabine-based regimens were associated with an improved overall response rate (ORR) of 70% vs 33% (p < 0.001) and overall survival (OS) (HR 0.541, [0.292-1.001], p = 0.05). No difference in efficacy between different cytarabine-based regimens was detected, but R-HyperCVAD/R-MA was associated with increased hospitalisation and transfusion requirements. Patients undergoing ASCT demonstrated an improved median OS (HR 0.108 [0.015-0.796], p = 0.029) but were significantly younger. These results reaffirm the use of cytarabine in MCL for selected patients aged over 60. Such regimens should be strongly considered for this population in frontline therapy.
Databáze: MEDLINE
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