Sawalha Yazeed, Hill Brian T, Rybicki Lisa A, Sun Danyu, Dean Robert M, Jagadeesh Deepa, Hamilton Betty K, Gerds Aaron T, Sobecks Ronald M, Andresen Steven, Liu Hien K, Majhail Navneet S, Pohlman Brad, Kalaycio Matt E, Bolwell Brian J, Smith Mitchell R
Taussig Cancer Institute, Department of Medical Oncology and Hematology, Cleveland Clinic, Cleveland, OH.
Taussig Cancer Institute, Department of Medical Oncology and Hematology, Cleveland Clinic, Cleveland, OH.
Clin Lymphoma Myeloma Leuk. 2018 Jan;18(1):e95-e102. doi: 10.1016/j.clml.2017.11.002. Epub 2017 Dec 6.
Young fit patients with mantle cell lymphoma (MCL) are commonly treated with induction chemotherapy followed by high-dose chemotherapy and autologous hematopoietic cell transplantation (AHCT). Induction regimens with modifications of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) and/or incorporation of high-dose cytarabine (HDAC) appear more effective than R-CHOP alone.
We adopted a modification of the Nordic protocol using standard, rather than higher dose R-CHOP, alternating with HDAC (rituximab plus HDAC), for 3 cycles each or, for patients already treated with R-CHOP alone before referral for AHCT, an additional 2 cycles of rituximab plus HDAC. We herein report our experience with 28 patients treated with this regimen who proceeded to AHCT, and compare their outcomes with patients treated with either standard-dose R-CHOP (n = 38) or R-HCVAD/MA (cyclophosphamide, vincristine, doxorubicin, dexamethasone alternating with methotrexate, and cytarabine; n = 21), before AHCT.
With a median follow-up duration of 26 months, our data show that this modification of the Nordic regimen is a highly effective pre-AHCT first-line therapy for MCL (3-year progression-free and overall survival rates of 69% and 75%, respectively).
By using a less intense induction, this regimen can serve as a platform for combined use of novel agents, with less risk of additive toxicity.
年轻健康的套细胞淋巴瘤（MCL）患者通常先接受诱导化疗，然后进行大剂量化疗和自体造血细胞移植（AHCT）。对R-CHOP（利妥昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松）进行改良和/或加入大剂量阿糖胞苷（HDAC）的诱导方案似乎比单纯使用R-CHOP更有效。
我们采用了北欧方案的改良方案，使用标准剂量而非高剂量的R-CHOP，与HDAC（利妥昔单抗加HDAC）交替使用，各进行3个周期；对于在转诊接受AHCT之前已单独接受R-CHOP治疗的患者，再额外进行2个周期的利妥昔单抗加HDAC治疗。我们在此报告28例接受该方案治疗并进行AHCT的患者经验，并将其结果与AHCT前接受标准剂量R-CHOP（n = 38）或R-HCVAD/MA（环磷酰胺、长春新碱、阿霉素、地塞米松与甲氨蝶呤和阿糖胞苷交替使用；n = 21）治疗的患者进行比较。
中位随访时间为26个月，我们的数据表明，北欧方案的这种改良是MCL在AHCT前非常有效的一线治疗方案（3年无进展生存率和总生存率分别为69%和75%）。
通过使用强度较低的诱导方案，该方案可作为联合使用新型药物的平台，且附加毒性风险较低。
