NEJM Study Seeks Best Treatment For Elderly Mantle Cell Patients

Mantle cell lymphoma remains one of the more elusive subtypes of B-cell non-Hodgkin's lymphomas, and patient outcomes remain fairly poor. This is especially true of the elderly. Fortunately, a recent paper published in the New England Journal of Medicine might help make treatment options a little clearer for oncologists treating these patients.

The trial

Researchers from the Netherlands carried out a randomized trial of more than 500 patients diagnosed with mantle cell lymphoma (only stage I diagnoses were excluded), with a median age of 70. Patients were randomized into one of two treatment arms:

-- Six cycles of rituximab, fludarabine, and cyclophosphamide (R-FC) every 28 days
-- Eight cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) every 21 days

Patients who showed a response to treatment were then randomized again into either maintenance therapy with rituximab, or maintenance therapy with interferon alfa.

The results

Overall survival was higher in the R-CHOP arm (4 year survival rate 62%) compared to the R-FC arm (47%), and the former arm also saw fewer hematologic toxic effects.

Furthermore, patients randomized to rituximab maintenance saw a significantly higher 4 year survival (87%) compared to interferon alfa (63%).

Implications

Their results suggest that R-CHOP followed by rituximab maintenance therapy offers the elderly mantle cell lymphoma patient with the greatest odds of treatment success.

Source: NEJM