Professional Documents
Culture Documents
Cure For Mantle Cell Lymphoma Within Reach, Says Expert
Cure For Mantle Cell Lymphoma Within Reach, Says Expert
Cure For Mantle Cell Lymphoma Within Reach, Says Expert
CureforMantleCellLymphomaWithinReach,SaysExpert
How to Minimize
Conicts of Interest in
Academic Oncology
Questioning Ethics of
Costly Drugs for
Metastatic Cancer
Childhood Cancer
Survivors: Genetic
Clues Help Prevent
Late Effects
EDITORS'RECOMMENDATIONS
Standard of Care in
Older Patients With
Mantle Cell Lymphoma
My Alerts
Clickthetopicbelowtoreceiveemails
whennewarticlesareavailable.
RELATEDDRUGS&DISEASES
Non-Hodgkin Lymphoma
Imaging in Thoracic Non-Hodgkin
Lymphoma
Non-Hodgkin Lymphoma Guidelines
Thereviewemphasizesthefactthatpatientageand
comorbiditiesaretheprimaryfactorsthatshoulddictatethe
initialapproachtotreatment.
IntensiveTherapyforYoung,FitPatients
ForpatientswithMCLwhoareaged65yearsoryoungerand
whoarewithoutsignificantcomorbidities,thebestresultshave
beenseenwithintensivetherapywithregimensthatcontain
highdosecytarabine(HDAC)consolidatedwithhighdose
chemotherapyandautologousstemcelltransplantation
(ASCT).
WhenASCTisplanned,theoptionsforinductionincludethe
NordicLymphomaGroupMCL2regimen(rituximabwithdose
escalatedcyclophosphamideanddoxorubicin,vincristine,
prednisone[RmaxiCHOP]alternatingwithHDAC)and
alternatingcyclesofRCHOPanddexamethasone,cisplatin,
cytarabine(DHAP).
AnalternativeapproachwithoutASCTforyounger,fitpatients
ishyperfractionatedcyclophosphamide,vincristine,
doxorubicin,dexamethasonealternatingwithhighdose
methotrexate,andcytarabinewithrituximab(Rhyper
CVAD/MA).
MOSTPOPULARARTICLES
AccordingtoPHYSICIANS
"Thesetwointensivetherapieshaveproducedoverallsurvival
exceeding10years.Suchoverallsurvivalhasnotbeen
achievedbysalvagetherapies,suchasRCHOPor
bendamustine,"DrWangsaid.
"Thisisbasedonthetheory
thatmantlecelllymphomaismostvulnerabletofrontlineattack.Thisis
mostimportantforyoungandfitpatients.Ifyoumessupwiththe
frontlinetherapy,youhavemissedthechanceforlongtermremission.
Ifyougiveyoung,fitpatientssalvagetherapy,theirdiseasewillrelapse
quickly,theywillgetintoapatternofconstanttherapies,andtheywill
diefromtheirdiseasemuchsoonerthan10years,"hesaid.
If you mess up
Toimproveonthetolerabilityofsuchintensivetherapy,MDAnderson
hasdesignedaphase2studyinyounger,treatmentnaivepatientsthat
usesaleadinchemotherapyfreewindowperiodwithrituximaband
ibrutinibfor6to12monthsfollowedbyabbreviated,responseadaptedRhyperCVAD/MA,DrWang
said.
"Theaimofthisstudyistokeepthesameefficacyoftheintensivetherapiesbuttodramatically
decreasetheirtoxicities.Afterweusetherituximabandibrutinib,thenthechemotherapywillbecutfrom
68cyclesto46cycles,"hesaid.
IntensivetherapyistootoxicforpatientswithMCLwhoareolderthan65yearsatdiagnosis.Forthese
patients,thechoicescurrentlyareRCHOPfollowedbymaintenancerituximabor
http://www.medscape.com/viewarticle/857424#vp_2
1/2
23/11/2016
CureforMantleCellLymphomaWithinReach,SaysExpert
bendamustine/rituximab(BR)salvagetherapies,DrWangsaid.
However,RCHOPandBRarebeingphasedout,becausebettertherapeuticchoiceshaveemergedfor
thisgroupofpatients.
"RCHOPplusibutrinibisshowinggoodresults.Also,bendamustine/rituximabplusibutrinibisbeing
studiedinphase3clinicaltrialsin550patientsfrom350centersworldwide.Resultsareexpectedtobe
availableinthemiddleof2016,"hesaid.
MedianSurvivalHasBeenDoubled
"Wehavemadesomuchprogressintreatingmantlecelllymphoma.Itusedtohaveamediansurvivalof
3to5years,butinyoungerpatientstreatedwithintensiveregimens,theoverallsurvivalnowexceeds
10years,"DrWangsaid.
Inelderlypatients,thegainshavenotbeenasdramatic,buttheuseofmaintenancerituximabafterR
CHOPresultsina4yearoverallsurvivalof79%.BRappearsatleastaseffectiveandhaslesstoxicity,
althoughlongerfollowupisneededtoestablishtheimpactofBRonoverallsurvival,asarestudiesthat
confirmsurvivalbenefitfromrituximabmaintenanceafterBR.
"Advancesinthetreatmentofpatientswithrelapsed/refractoryMCLhavebeenmadewiththeapproval
ofbortezomib,lenalidomide,andibrutinib.Theseagentsarenowincorporatedintofrontlinetreatment
strategiesandshouldfurtherimproveresponseratesandsurvival,"hesaid.
DrWanghasfinancialrelationshipswithJanssenPharmaceuticals,AcertaPhrma,Celltrion,
Pharmacyclics,andOnyx.
JClinOncol.PublishedonlineJanuary11,2016.Abstract
PreviousPage
2of2
Comment
Commentingislimitedtomedicalprofessionals.TocommentpleaseLogin.
LATESTINHEMATOLOGYONCOLOGY
All material on this website is protected by copyright, Copyright 1994-2016 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
http://www.medscape.com/viewarticle/857424#vp_2
2/2