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R-hyper-CVAD versus R-CHOP/cytarabine with high-dose therapy and autologous haematopoietic stem cell support in fit patients with mantle cell lymphoma: 20 years of single-center experience

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Abstract

Standard of care for untreated mantle cell lymphoma (MCL) is still debated. At the University Hospital Zurich, advanced MCL in physically fit patients is treated either with rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone induction followed by consolidating high-dose chemotherapy and autologous stem cell support (R-CHOP/HD-ASCT), or with rituximab plus fractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone alternating with high-dose methotrexate-cytarabine (R-hyper-CVAD/MTX-AraC) without consolidating HD-ASCT upon physicians’ and patients’ choice. We retrospectively analysed the outcome and therapy tolerance in patients with MCL treated with R-CHOP/HD-ASCT or R-hyper-CVAD/MTX-AraC at the University Hospital Zurich between January 1996 and January 2016. Forty-three patients were included; 29 patients received R-CHOP/HD-ASCT and 14 patients R-hyper-CVAD/MTX-AraC. Mean age at diagnosis was 54.4 years (range 38–68 years). Thirty-five patients (81.4%) completed the entire first-line therapy (n = 24 in the R-CHOP/HD-ASCT group, n = 11 in the R-hyper-CVAD group). Of those, all patients responded and 97% achieved a complete remission (CR). With a mean follow-up of 5.7 years 10-year progression-free survival (PFS) for all patients was 32% and overall survival (OS) was 76%, with no difference between the two therapy groups. Complication-induced hospitalisation rate, haematological toxicity and economic burden were significantly higher in the R-hyper-CVAD therapy group. In contrast, quality of life and global health state were better in the R-hyper-CVAD therapy group. Both first-line therapies showed similar outcome with a median OS longer than 10 years. Due to significantly lower haematological toxicity and lower economic burden, we recommend R-CHOP/HD-ASCT as first-line therapy in fit adult patients with advanced MCL.

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Acknowledgments

We thank the patients for their willingness to participate.

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Authors and Affiliations

  1. Division of Haematology, University Hospital and University of Zurich, Zurich, Switzerland

    Fabienne Widmer, Stefan Balabanov, Bernhard Gerber, Markus G. Manz & Jeroen S. Goede

  2. Institute for Surgical Pathology, University Hospital and University of Zurich, Zurich, Switzerland

    Davide Soldini

  3. Division of Oncology, University Hospital and University of Zurich, Zurich, Switzerland

    Panagiotis Samaras

  4. Division of Haematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland

    Bernhard Gerber

  5. Division of Oncology and Haematology, Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland

    Jeroen S. Goede

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  1. Fabienne Widmer
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Correspondence to Jeroen S. Goede.

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Widmer, F., Balabanov, S., Soldini, D. et al. R-hyper-CVAD versus R-CHOP/cytarabine with high-dose therapy and autologous haematopoietic stem cell support in fit patients with mantle cell lymphoma: 20 years of single-center experience. Ann Hematol 97, 277–287 (2018). https://doi.org/10.1007/s00277-017-3180-x

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