Prolonged immunochemotherapy with rituximab, cytarabine and fludarabine added to cyclophosphamide, doxorubicin, vincristine and prednisolone and followed by rituximab maintenance in untreated elderly patients with mantle cell lymphoma: a prospective study by the Finnish Lymphoma Group

AbstractThere is no consensus on treatment strategies for elderly patients with mantle cell lymphoma(MCL). In this prospective phase II study we investigated whether the poor outcome could be improved, with reasonable toxicity, by prolonging the immunochemotherapy. Ten cycles of alternating cyclophosphamide, doxorubicin, vincristineand prednisolone (CHOP)/ cytarabine(AraC) with eight doses of rituximab(R) were given as induction. The potential synergism of intermediate-dose AraC and fludarabinewas tested in cycles 6–8. Induction was followed by bimonthly rituximabmaintenance for 2 years. The median age of the 60 included patients was 74 years, and the Mantle Cell Lymphoma International Prognostic Index(MIPI) was intermediate or high risk in 98% of the patients. The overall response rate was 95% (complete response/complete response unconfirmed 87%). The response of 11 patients improved with cycles 6–8 (R- fludarabine-AraC). Progression-free survivalwas 70% and overall survival 72% at 4 years, respect...