Cytarabine-based induction immunochemotherapy in the front-line treatment of older patients with mantle cell lymphoma

Sumita Ratnasingam, Joshua Casan, Jake Shortt, Eliza Hawkes, Michael Gilbertson, Zoe McQuilten, George Grigoriadis, Kay Thwe Htun, Swe Myo Htet, Philip Campbell, Khai Li Chai, Hang Quach, Sushrut Patil, Stephen Opat

Research output: Contribution to journalArticleResearchpeer-review

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.

Original languageEnglish
Article number13544
Number of pages7
JournalScientific Reports
Volume9
Issue number1
DOIs
Publication statusPublished - 19 Sep 2019

Cite this

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title = "Cytarabine-based induction immunochemotherapy in the front-line treatment of older patients with mantle cell lymphoma",
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.",
author = "Sumita Ratnasingam and Joshua Casan and Jake Shortt and Eliza Hawkes and Michael Gilbertson and Zoe McQuilten and George Grigoriadis and Htun, {Kay Thwe} and Htet, {Swe Myo} and Philip Campbell and Chai, {Khai Li} and Hang Quach and Sushrut Patil and Stephen Opat",
year = "2019",
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language = "English",
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Cytarabine-based induction immunochemotherapy in the front-line treatment of older patients with mantle cell lymphoma. / Ratnasingam, Sumita; Casan, Joshua; Shortt, Jake; Hawkes, Eliza; Gilbertson, Michael; McQuilten, Zoe; Grigoriadis, George; Htun, Kay Thwe; Htet, Swe Myo; Campbell, Philip; Chai, Khai Li; Quach, Hang; Patil, Sushrut; Opat, Stephen.

In: Scientific Reports, Vol. 9, No. 1, 13544, 19.09.2019.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Cytarabine-based induction immunochemotherapy in the front-line treatment of older patients with mantle cell lymphoma

AU - Ratnasingam, Sumita

AU - Casan, Joshua

AU - Shortt, Jake

AU - Hawkes, Eliza

AU - Gilbertson, Michael

AU - McQuilten, Zoe

AU - Grigoriadis, George

AU - Htun, Kay Thwe

AU - Htet, Swe Myo

AU - Campbell, Philip

AU - Chai, Khai Li

AU - Quach, Hang

AU - Patil, Sushrut

AU - Opat, Stephen

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AB - 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.

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