Department of Medicine, University of Washington/Seattle Cancer Care Alliance, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
Taussig Cancer Institute, Hematologic Oncology and Blood Disorders, Cleveland Clinic, Cleveland, OH.
Clin Lymphoma Myeloma Leuk. 2019 Jan;19(1):48-52. doi: 10.1016/j.clml.2018.10.006. Epub 2018 Oct 17.
Initial treatment of mantle cell lymphoma (MCL) incorporating autologous stem cell transplantation affords long-term remissions, but relapses still occur. Optimal pretransplant therapy will afford high complete response rates and not impair stem cell collection. Incorporation of bortezomib represents a natural evolution of pretransplant therapy, given its proven first-line efficacy and minimal impact on stem cell collection.
At the University of Washington/Seattle Cancer Care Alliance and the Cleveland Clinic Foundation, we developed modified VR-CAP/R+ara-C (bortezomib, rituximab, cyclophosphamide, doxorubicin, and prednisone, alternating with rituximab and high-dose cytarabine), for transplant-eligible patients with MCL. This regimen was administered as standard-of-care, pretransplant therapy to consecutive patients with MCL from April 2015 to the present.
A total of 37 patients were treated with this regimen, including 18 at the University of Washington/Seattle Cancer Care Alliance and 19 at the Cleveland Clinic Foundation. Most patients had intermediate- or high-risk disease by both (mantle-cell lymphoma international prognostic index (MIPI)-B and MIPI-C category. Complete response to induction was achieved in 32 (86%) of 37 evaluable patients; 2 achieved partial response, and 3 had primary refractory disease. Stem cell collection was successful in 1 attempt in 30 of 32 patients. The median follow-up of survivors measured from start of treatment is 17.4 months. Five patients have progressed, and 4 have died (2 owing to lymphoma, 2 from toxicity).
Modified VR-CAP/R+ara-C is feasible pretransplant therapy for patients with MCL and is associated with a high rate of complete response and eligibility for autologous stem cell transplantation.
包含自体干细胞移植的套细胞淋巴瘤（MCL）初始治疗可提供长期缓解，但仍会复发。最佳的移植前治疗将提供高完全缓解率，且不会损害干细胞采集。硼替佐米的加入代表了移植前治疗的自然发展，因为它已被证明具有一线疗效，并且对干细胞采集的影响最小。
在华盛顿大学/西雅图癌症护理联盟和克利夫兰诊所基金会，我们为符合移植条件的 MCL 患者开发了改良的 VR-CAP/R+ara-C（硼替佐米、利妥昔单抗、环磷酰胺、多柔比星和泼尼松，与利妥昔单抗和高剂量阿糖胞苷交替使用）。该方案自 2015 年 4 月至今，作为标准护理用于连续的 MCL 患者的移植前治疗。
共有 37 例患者接受了该方案治疗，其中 18 例在华盛顿大学/西雅图癌症护理联盟，19 例在克利夫兰诊所基金会。大多数患者根据（MIPI-B 和 MIPI-C 分类的套细胞淋巴瘤国际预后指数（MIPI））具有中高危疾病。37 例可评估患者中，32 例（86%）达到诱导缓解完全缓解；2 例部分缓解，3 例原发耐药。30 例患者中的 1 例成功采集了干细胞。从治疗开始时测量，存活者的中位随访时间为 17.4 个月。5 例患者进展，4 例死亡（2 例死于淋巴瘤，2 例死于毒性）。
改良的 VR-CAP/R+ara-C 是 MCL 患者移植前治疗的可行方法，与高完全缓解率和自体干细胞移植的资格相关。
