Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Semin Hematol. 2011 Jul;48(3):208-13. doi: 10.1053/j.seminhematol.2011.03.008.
Treatment of elderly patients with a mantle cell lymphoma (MCL) is a challenge. High-dose cytarabine and autologous transplantation, both important components of the treatment in younger patients, are not feasible for most elderly patients. However, in fit elderly patients long progression-free survival and molecular remissions are possible. The regimen most commonly used is rituximab combined with an anthracycline-combination therapy, ie, R-CHOP. An alternative is rituximab combined with a purine analogue-containing regimen, ie, fludarabine with cyclophosphamide (R-FC). The results of a large randomized study comparing these two regimens are expected soon. Maintenance therapy with rituximab after induction improves progression-free survival. Relapse of lymphoma will occur in all patients, as cure of MCL is not yet achieved with standard therapy. Second-line treatment regimens with reasonable results are described. Treatment of the frail elderly patient and of patients after first relapse should aim at reducing symptoms and maintaining quality of life. It therefore should be individualized, and benefits and possible side effects should be carefully balanced. It is advised to include patients with MCL in clinical trials to obtain a better understanding of the value of different treatment options and new developments.
治疗老年套细胞淋巴瘤（MCL）患者颇具挑战。大剂量阿糖胞苷和自体移植是年轻患者治疗的重要组成部分，但对于大多数老年患者来说并不可行。然而，对于身体状况良好的老年患者，可以实现无进展生存期和分子缓解的延长。最常用的方案是利妥昔单抗联合蒽环类联合化疗，即 R-CHOP。另一种选择是利妥昔单抗联合含嘌呤类似物的方案，即氟达拉滨联合环磷酰胺（R-FC）。比较这两种方案的大型随机研究结果预计很快就会公布。诱导后用利妥昔单抗维持治疗可改善无进展生存期。所有患者都会出现淋巴瘤复发，因为标准治疗尚未实现 MCL 的治愈。描述了一些二线治疗方案，具有合理的疗效。对于体弱的老年患者和首次复发后的患者，治疗的目的应该是减轻症状并维持生活质量。因此，应根据患者的具体情况进行个体化治疗，并仔细权衡获益和可能的副作用。建议将 MCL 患者纳入临床试验，以更好地了解不同治疗方案和新进展的价值。
