The prognosis of elderly patients with mantle-cell lymphoma (MCL) is dismal; most patients relapse following treatment with rituximab-based regimens, such as R-CHOP. This situation prompted Hanneke Kluin-Nelemans and colleagues to address two questions: “firstly, can a new regimen consisting of fludarabine, cyclophosphamide and rituximab (R-FC) induce a higher remission rate than R-CHOP and, secondly, can maintenance therapy with rituximab prolong the remission duration?”
A total of 532 patients were randomized to R-CHOP or R-FC; the 316 responders were then randomized to maintenance therapy with rituximab or interferon-alfa (IFN-α). Although complete remission rates were similar for the two induction regimens, more patients had progressive disease with R-FC therapy. Importantly, overall survival was significantly shorter for R-FC compared with R-CHOP, and haematological toxicity was more frequent for patients treated with R-FC.
Kluin-Nelemans highlights the key results from the second part of the study, “rituximab maintenance significantly improved 4-year overall survival compared with IFN-α in patients responding to R-CHOP. This is the first study to show a survival gain for rituximab maintenance.” This large study with two randomizations inbuilt in its design provides, “a new standard for older patients with MCL: induction therapy with R-CHOP followed by maintenance with rituximab until disease progression.” Kluin-Nelemans suggests that future work should incorporate new drug combinations for induction and additional drugs to rituximab maintenance adapted for older patients—an undertaking that will require an international networking effort.
ORIGINAL RESEARCH PAPER
Kluin-Nelemans, H. C. et al. Treatment of older patients with mantle-cell lymphoma. N. Engl. J. Med. 367, 520–531 (2012).
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Hutchinson, L. For elderly, R-CHOP and maintain. Nat Rev Clin Oncol 9, 551 (2012). https://doi.org/10.1038/nrclinonc.2012.152
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DOI: https://doi.org/10.1038/nrclinonc.2012.152