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Haematological cancer

Cytarabine — new standard of care for MCL

Nature Reviews Clinical Oncology volume 13, pages 464–465 (2016)Cite this article

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In the past decade, the results of a European Mantle Cell Lymphoma (MCL) Network trial showed that autologous stem-cell transplantation (ASCT) improved the survival of patients aged ≤65 years with MCL receiving induction immunotherapy and consolidation chemotherapy. The addition of high-dose cytarabine plus methotrexate to a hyper-CVAD regimen was subsequently tested, with results less positive than expected owing to low tolerability of this treatment — mostly attributable to methotrexate. The addition of only high-dose cytarabine to an R-CHOP induction-regimen with subsequent ASCT has now been tested in the MCL Younger trial from the same network, coordinated by Martin Dreyling.

In this international study, patients aged 18–65 years with treatment-naive MCL were randomly assigned to receive either R-CHOP followed by myeloablative radiochemotherapy (control) or R-CHOP alternated with R-DHAP followed by myeloablative radiochemotherapy that included high-dose cytarabine (cytarabine group). Subsequently, all patients were scheduled to receive ASCT. After a median follow up duration of 6.1 years, the median time to treatment failure was significantly longer in the cytarabine group versus control group (9.1 years and 3.9 years, respectively; P = 0.038). After induction therapy, the proportion of patients with no minimal residual disease detected in peripheral blood and bone marrow was also substantially higher in the cytarabine group versus the control group; a similar outcome was observed after ASCT. Similar toxicities were observed for both groups, with the exception of grade 3–4 haematological toxicities and grade 1–2 renal toxicities, which were higher with high-dose cytarabine.

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References

  1. Hermine, O. et al. Addition of high-dose cytarabine to immunochemotherapy before autologous stem-cell transplantation in patients aged 65 years or younger with mantle cell lymphoma (MCL Younger): a randomised, open-label, phase 3 trial of the European Mantle Cell Lymphoma Network. Lancet http://dx.doi.org/10.1016/S0140-6736(16)00739-X (2016)

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  1. Diana Romero
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Romero, D. Cytarabine — new standard of care for MCL. Nat Rev Clin Oncol 13, 464–465 (2016). https://doi.org/10.1038/nrclinonc.2016.104

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