Untreated aggressive mantle cell lymphoma: Results with intensive chemotherapy without stem cell transplant in elderly patients

Aggressive mantle cell lymphoma has a poor prognosis with current therapy a nd occurs frequently in an elderly population which cannot receive stem cel l transplantation. Newer aggressive therapies are needed. In this study, 25 consecutive previously untreated patients 65 years or older with MCL were enrolled in two sequential phase II trials. The program included fractionat ed cyclophosphamide 1,800 mg/m(2) administered with doxorubicin, vincristin e and dexamethasone (hyper-CVAD), alternating every 3 weeks with high doses of methotrexate and cytarabine (M-A) for up to 8 cycles. Cytarabine was gi ven as 1 gram/m(2)/dose. Six of 14 patients tested (50%) presented with gas trointestinal (GI) involvement, but only one had GI symptoms. The overall r esponse rate was 92% (95% C.I. 73-99) and the complete remission (CR) rate was 68% (95% C.I. 46-85). With a median follow-up of 17 months, the median FFS for the entire group is 15 months. Hematologic toxicity was significant but only 5% of the cycles were associated with grade 3 infection. Treatmen t-related death occurred in 2 patients. In conclusion, GI involvement by MC L is common in this age group. Hyper-CVAD alternating with M-A with adjustm ent of the cytarabine is an active regimen in this elderly group of patient s with untreated MCL and the toxicity is manageable. Strategies for eradica ting minimal residual disease are still needed.