TREATMENT OF MANTLE-CELL LYMPHOMAS WITH THE VAD + - CHLORAMBUCIL REGIMEN WITH OR WITHOUT SUBSEQUENT HIGH-DOSE THERAPY AND PERIPHERAL-BLOOD STEM-CELL TRANSPLANTATION/

Background: MCL is a well-described clinicobiological entity that pres ents the worst prognosis of the small-cell lymphomas. No treatment is known as the reference treatment. On the basis, first, of clinicobiolo gical similarities between MCLs and multiple myelomas and, second, of our experience of chlorambucil in high intermittent dose in MCLs, we h ave treated MCL with the VAD regimen both with and without chlorambuci l. Patients and methods. Thirty disseminated MCL patients from three i nstitutions, most in relapse (70%), were treated with the classical VA D regimen: 4 weeks VAD for 12 patients and VAD with 12 mg chlorambucil (d20-d29) for 5 weeks (VAD + C) for 18 patients. Five patients receiv ed complementary high-dose therapy (Alkeran or cyclophosphamide HD wit h TBI) and peripheral blood stem-cell transplantation. Results. Comple te response was achieved in 43% of the patients in which 84.5% were tr eated by VAD + C. The median overall survival from the diagnosis was 5 2 months, and from the first VAD +/- C (OSvad) was 22.5 months, with a 20.5 month (0-75) median follow-up between diagnosis and the first VA D +/- C, The OSvad was significantly better for patients with fewer th an two prognostic factors (ECOG, lymphocytosis, blastic variant, LDH l evel, and Ki-67 score). Four of five patients treated with HDT and PBS CT were alive in CR 12.5 months (7-22) after the first VAD +/- C regim en. Conclusion: The VAD regimen appears effective in disseminated MCL patients and even better when associated with chlorambucil. HDT and PB SCT appear promising in younger patients in CR before HDT. A multicent er prospective study is in preparation to confirm these encouraging re sults.