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Title: Cytarabine-based induction immunochemotherapy in the front-line treatment of older patients with mantle cell lymphoma.
Austin Authors: Ratnasingam, Sumita;Casan, Joshua;Shortt, Jake;Hawkes, Eliza A ;Gilbertson, Michael;McQuilten, Zoe;Grigoriadis, George;Htun, Kay Thwe;Htet, Swe Myo;Campbell, Philip;Chai, Khai Li;Quach, Hang;Patil, Sushrut;Opat, Stephen
Affiliation: Department of Medical Oncology, Eastern Health, Melbourne, Australia
Department of Haematology, St Vincent's Hospital, Melbourne, Australia
Department of Haematology, Andrew Love Cancer Centre, University Hospital Geelong, Geelong, Australia
Department of Medical Oncology, Olivia Newton John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
Department of Haematology, Monash Health, Melbourne, Australia
School of Clinical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
Department of Haematology, Alfred Health, Melbourne, Australia
Department of Clinical Haematology, Olivia Newton John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 19-Sep-2019 2019
Publication information: Scientific Reports 2019; 9(1): 13544
Abstract: The role of cytarabine-based induction and autologous stem cell transplantation (ASCT) in front-line treatment of younger patients with mantle cell lymphoma (MCL) is well established, however the utility of intensive approaches in older patients remains unclear. This retrospective study compared first line treatment outcomes in patients aged 60 years or more, treated at six tertiary centres between 2000-2015. 70 patients included had a median age of 69 (60-91) and most (94%) demonstrated advanced stage disease. Treatment regimens included: R-CHOP-like (n = 39), alternating R-CHOP/R-DHAC (n = 10), R-HyperCVAD/R-MA (n = 7), R-CHOP/Cytarabine (Nordic Protocol) (n = 10) and other (n = 4). 16 patients underwent an ASCT. The median follow-up for surviving patients was 37 months. Compared to R-CHOP-like therapies, cytarabine-based regimens were associated with an improved overall response rate (ORR) of 70% vs 33% (p < 0.001) and overall survival (OS) (HR 0.541, [0.292-1.001], p = 0.05). No difference in efficacy between different cytarabine-based regimens was detected, but R-HyperCVAD/R-MA was associated with increased hospitalisation and transfusion requirements. Patients undergoing ASCT demonstrated an improved median OS (HR 0.108 [0.015-0.796], p = 0.029) but were significantly younger. These results reaffirm the use of cytarabine in MCL for selected patients aged over 60. Such regimens should be strongly considered for this population in frontline therapy.
DOI: 10.1038/s41598-019-49776-9
ORCID: 0000-0002-0308-6458
PubMed URL: 31537857
Type: Journal Article
Appears in Collections:Journal articles

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