Treatment of mantle-cell lymphomas with the VAD +/− chlorambucil regimen with or without subsequent high-dose therapy and peripheral blood stem-cell transplantation

1569-8041

mantle-cell lymphoma ; non-Hodgkin's lymphoma ; VAD regimen

Springer Online Journal Archives 1860-2000

Medicine

Abstract Background: MCL is a well-described clinicobiological entity thatpresents the worst prognosis of the small-cell lymphomas. No treatment isknown as the reference treatment. On the basis, first, of clinicobiologicalsimilarities between MCLs and multiple myelomas and, second, of our experienceof chlorambucil in high intermittent dose in MCLs, we have treated MCL withthe VAD regimen both with and without chlorambucil. Patients and methods: Thirty disseminated MCL patients from threeinstitutions, most in relapse (70%), were treated with the classicalVAD 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 receivedcomplementary high-dose therapy (Alkeran or cyclophosphamide HD with TBI) andperipheral blood stem-cell transplantation. Results: Complete response was achieved in 43% of the patientsin which 84.5% were treated by VAD + C. The median overall survivalfrom the diagnosis was 52 months, and from the first VAD +/− C (OSvad)was 22.5 months, with a 20.5 month (0–75) median follow-up betweendiagnosis and the first VAD +/− C. The OSvad was significantly betterfor patients with fewer than two prognostic factors (ECOG, lymphocytosis,blastic variant, LDH level, and Ki-67 score). Four of five patients treatedwith HDT and PBSCT were alive in CR 12.5 months (7–22) after the firstVAD +/− C regimen. Conclusion: The VAD regimen appears effective in disseminated MCLpatients and even better when associated with chlorambucil. HDT and PBSCTappear promising in younger patients in CR before HDT. A multicenterprospective study is in preparation to confirm these encouraging results.

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