Mantle Cell Treatment Options
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?
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.