Mantle Cell Treatment Options

Last Modified: May 29, 2008

Question:

Dear OncoLink "Ask The Experts,"

I have Mantle cell lymphoma and have been given 2 options for treatment, hyper-CVAD or R-CHOP. From my readings, both are considered first-line approaches for treating MCL, however, hyper-CVAD is quite demanding on the patient. Why is hyper-CVAD preferred by some cancer centers over the less physically demanding R-CHOP? Does it have any advantages?

Answer:

Babis (Charalambos) Andreadis, MD, Assistant Professor in Medicine in the Division of Hematology/Oncology at the Abramson Cancer Center and an Associate Scholar in the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania, responds:

Mantle cell lymphoma is an aggressive lymphoma that shares some of the issues with chemo-resistance seen in indolent lymphomas. Treatment considerations for this disease have traditionally revolved around 2 phases: remission induction and post-remission therapy. In terms of remission induction, CHOP and R-CHOP have been examined in the '90s and early '00s with discouraging results. It is not clear that any patient achieves a long-term remission with this regimen. As a matter of fact, there is a constant rate of relapse on this therapy, with the median duration of response and time to treatment failure being less than 2 years in the large randomized studies. In fact, most studies that have shown good long-term results with CHOP/R-CHOP have utilized it in conjunction with a stem cell transplant upon completion of therapy.
The hyper-CVAD+/- rituxan induction regimen was first developed in an attempt to overcome chemo-resistance in this disease. Data from MD Anderson suggest a significant response rate and duration of response utilizing it alone or followed by stem cell transplantation. As a matter of fact, 72% of patients treated with hCVAD/transplant were in remission 3 years after treatment, compared to 17% of patients treated with CHOP-like regimens at MD Anderson previously. In my opinion, hCAVD+/- rituxan is the induction regimen of choice for this disease. The question of a stem cell transplantation as post-remission therapy is still an open one and depends on individual factors and preferences.

Blogs

Radiate
by Rodney Warner, JD
March 16, 2011

Would You Want to be in the Box?
by Rodney Warner, JD
November 29, 2010

A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
R
S
T
U
V
X
Y
Z
#
 
A
B
C
E
F
G
H
K
L
M
N
O
P
R
S
T
U
V
 
 
Stay informed with the latest information from OncoLink!   Subscribe to OncoLink eNews
View our newsletter archives