Klener Pavel, Fronkova Eva, Belada David, Forsterova Kristina, Pytlik Robert, Kalinova Marketa, Simkovic Martin, Salek David, Mocikova Heidi, Prochazka Vit, Blahovcova Petra, Janikova Andrea, Markova Jana, Obr Ales, Berkova Adela, Kubinyi Jozef, Vaskova Martina, Mejstrikova Ester, Campr Vit, Jaksa Radek, Kodet Roman, Michalova Kyra, Trka Jan, Trneny Marek
First Medical Department, Charles University General Hospital in Prague, Prague, Czech Republic.
Institute of Pathological Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
Hematol Oncol. 2018 Feb;36(1):110-115. doi: 10.1002/hon.2483. Epub 2017 Oct 30.
Implementation of cytarabine into induction therapy became standard of care for younger patients with mantle cell lymphoma (MCL). On the basis of its beneficial impact, many centers incorporated cytarabine at lower doses also into first-line treatments of elderly patients. We conducted a multicenter observational study that prospectively analyzed safety and efficacy of alternating 3 + 3 cycles of R-CHOP and R-cytarabine for newly diagnosed transplant-ineligible MCL patients. A total of 73 patients were enrolled with median age 70 years. Most patients had intermediate (39.7%) and high-risk (50.7%) disease according to MCL international prognostic index. Rituximab maintenance was initiated in 58 patients. Overall response rate reached 89% by positron emission tomography-computed tomography, including 75.3% complete remissions. Two patients (2.7%) did not complete the induction therapy because of toxicity. Three patients (4.1%) were considered nonresponders, which led to therapy change before completion of induction. Estimated progression-free survival and overall survival were 51.3% and 68.6% at 4 years, respectively. Mantle cell lymphoma international prognostic index, bulky disease (≥ 5 cm), and achievement of positron emission tomography-negativity independently correlated with progression-free survival. Grade 3 to 4 hematologic and nonhematologic toxicity was documented in 48% and 20.5% patients, respectively. Alternation of R-CHOP and R-cytarabine represents feasible and very effective regimen for elderly/comorbid MCL patients. This study was registered at GovTrial (clinicaltrials.gov) NCT03054883.
将阿糖胞苷应用于诱导治疗已成为年轻套细胞淋巴瘤（MCL）患者的标准治疗方案。基于其有益影响，许多中心也将低剂量阿糖胞苷纳入老年患者的一线治疗。我们进行了一项多中心观察性研究，前瞻性分析了R-CHOP和R-阿糖胞苷交替进行3 + 3周期治疗新诊断的不适合移植的MCL患者的安全性和疗效。共纳入73例患者，中位年龄70岁。根据MCL国际预后指数，大多数患者患有中危（39.7%）和高危（50.7%）疾病。58例患者开始使用利妥昔单抗维持治疗。通过正电子发射断层扫描-计算机断层扫描，总缓解率达到89%，其中完全缓解率为75.3%。2例患者（2.7%）因毒性未完成诱导治疗。3例患者（4.1%）被认为无反应，导致在诱导治疗完成前改变治疗方案。4年时的无进展生存率和总生存率估计分别为51.3%和68.6%。MCL国际预后指数、大包块疾病（≥5 cm）以及正电子发射断层扫描阴性的实现与无进展生存独立相关。分别有48%和20.5%的患者记录到3至4级血液学和非血液学毒性。R-CHOP和R-阿糖胞苷交替方案对于老年/合并症MCL患者是可行且非常有效的方案。本研究已在GovTrial（clinicaltrials.gov）注册，注册号为NCT03054883。
