VcR-CVAD Regimen Induces Durable Remissions in Mantle Cell Lymphoma
Incorporation of bortezomib into VcR-CVAD followed by rituximab maintenance demonstrated high rates of durable remissions.
SAN DIEGO – Among patients with mantle cell lymphoma, the incorporation of bortezomib into modified hyper-CVAD induction chemotherapy (VcR-CVAD) followed by rituximab maintenance demonstrated high rates of durable remissions comparable to those seen with more intensive chemotherapy and consolidative autologous hematopoietic cell transplantation.1
"There are limitations with hyper-CVAD due to older age of most adult mantle cell lymphoma patients and toxicity with this regimen," said lead investigator Julie E. Chang, MD, department of medicine, University of Wisconsin School of Medicine and Public Health, Madison. "Modified hyper-CVAD was developed to improve the toxicity profile."
The findings, which were presented at the American Society of Hematology (ASH) 58th Annual Meeting and Exposition, showed that treatment with VcR-CVAD, a moderate intensity chemotherapy regimen, was associated with 5-year progression-free survival and overall survival rates of 53.1% (95% CI, 37.9-75.5) and 69.8% (95% CI, 55.2-88.4), respectively. There was no significant difference in progression-free or overall survival with respect to age.
A total of 90% achieved an overall response, including 23 complete responses and 4 partial responses.
"Three of the 4 patients with a partial response improved to complete response during maintenance therapy," said Dr Chang.
Researchers enrolled 30 adult patients with histologically-confirmed mantle cell lymphoma who were treatment-naive with the exception of 1 cycle of CHOP/CHOP-like chemotherapy. Participants received VcR-CVAD induction chemotherapy every 21 days for 6 cycles. Patients achieving at least a partial response to induction therapy received rituximab consolidation weekly for 4 doses, followed by rituximab maintenance every 12 weeks for a total of 5 years.
After a median follow-up of 7.8 years in the surviving 20 patients, 50% are in ongoing remission. Researchers have observed no lymphoma relapse beyond 5 years, and there have been no late toxicities from VcR-CVAD or from rituximab maintenance during long-term follow-up.
"VcR-CVAD outcomes after greater than 7 years of follow-up show survival rates comparable with consolidative autologous transplant and R-hyperCVAD," Dr Chang noted.
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The findings suggest that VcR-CVAD remains an effective therapy choice for initial treatment of mantle cell lymphoma.
"VcR-CVAD is feasible and efficacious in older patients with mantle cell lymphoma," concluded Dr Chang. "There were no emerging toxicities on long-term follow-up, but 2-year maintenance rituximab is likely more tolerable."
- Chang JE, Peterson C, Carmichael LL, et al. Durable remissions with the VcR-CVAD regimen for mantle cell lymphoma (MCL), regardless of age: Long-term follow-up of a Wisconsin Oncology Network (WON) Study. Paper presented at: American Society of Hematology (ASH) 58th Annual Meeting and Exposition; December 3-6, 2016; San Diego, CA.