Commentary on Abstract #2804

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Article
OncologyONCOLOGY Vol 14 No 3
Volume 14
Issue 3

Mantle cell lymphoma is one of the most challenging of the NHLs. It exhibits the worst features of both the indolent and aggressive lymphomas. With its short survival of 2 ½ to 3 years, mantle cell lymphoma resembles an aggressive NHL, but,

Mantle cell lymphoma is one of the most challenging of the NHLs. It exhibits the worst features of both the indolent and aggressive lymphomas. With its short survival of 2 ½ to 3 years, mantle cell lymphoma resembles an aggressive NHL, but, like the follicular lymphomas, it is not curable. Many chemotherapeutic regimens can induce transient responses in patients with mantle cell histology. Encouraging results have been observed with the hyperCVAD (hyperfractionated cyclophosphamide, vincristine, Adriamycin, and dexamethasone) regimen followed by stem-cell transplantation (Khouri et al: J Clin Oncol 16:3803-3809, 1998). Nevertheless, additional approaches are needed.

In a phase I/II study published in 1998, about 32% of patients with mantle cell lymphoma responded to single-agent rituximab given in a schedule that was more intensive schedule than the standard program (Coiffier et al: Blood 92:1927-1932, 1998). More recently, the results of a European phase II trial of rituximab (Foran et al: J Clin Oncol 18:317, 2000) that included 34 newly diagnosed and 40 previously treated patients with mantle cell lymphoma showed response rates of 38% and 37%, respectively, including 10 CRs. The median duration of response was 1.2 years. Also using single-agent rituximab, Winkler et al (abstract #4419; see page 22) achieved two complete remissions in four patients with mantle cell lymphoma that lasted 8+ and 19+ months, respectively.

Howard and coworkers (abstract #2804) accrued 40 patients with newly diagnosed mantle cell lymphoma to a protocol employing CHOP plus rituximab as initial treatment. The complete remission rate was 33%, with unconfirmed complete responses (CRu) in 15% of patients, and PRs in 48%. In almost half of the patients, there was no detectable bcl-1 rearrangement after therapy. The median progression-free survival was 16.2 months. Unfortunately, even those patients who achieved a molecular response relapsed.

Therefore, whereas rituximab may play a therapeutic role in mantle cell lymphoma, successful treatment of this disease remains a difficult problem.

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Comparative Economic Analysis of the Treatment of Relapsed Low-Grade B-Cell Non-Hodgkin’s Lymphoma (NHL) in France Using CHOP, Fludarabine, or Rituximab
FHIT Gene, Smoking, and Cervical Cancer
Final Report on the Safety and Efficacy of Retreatment With Rituximab for Patients With Non-Hodgkins Lymphoma
Prospective, Randomized, Controlled Study of Zevalin Radioimmunotherapy Compared to Rituximab Immunotherapy for B-Cell, Non-Hodgkins Lymphoma: Interim Results
IOM Medical Error Estimates Questioned, But Legislation Considered
Less Toxic Therapies for Hodgkin’s Disease May Reduce Secondary Cancers
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Survival Rates Significantly Worse For African-Americans With Endometrial Cancer
Rituximab Has Significant Activity in Patients With Chronic Lymphocytic Leukemia
Responders to Rituximab Show Continued Tumor Regression Over Time and a Progression-Free Survival That Correlates With Response Classification
PhRMA Criticizes FDA’s Proposed Rule on Antibiotic Approvals
Phase II Study of Rituximab in Combination With CHOP in Patients With Previously Untreated Intermediate- or High-Grade Non-Hodgkin’s Lymphoma
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Reduced-Dose Zevalin Radioimmunotherapy for Relapsed or Refractory B-Cell Non-Hodgkin’s Lymphoma Patients With Preexisting Thrombocytopenia: Report of Interim Results of a Phase II Trial
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