Rituxan-HCVAD in Mantle Cell Lymphoma: To Transplant or Not To Transplant: The University of Pennsylvania Experience.

Mantle cell lymphoma is a difficult disease entity with no standard therapy. The best reported results for treatment of de novo patients has been from the MD Anderson Cancer Center with long term remission rates reported of 77%, using the HCVAD regimen in combination with autologous stem cell transplantation. (Khouri, ASH 1998) In later reports, the addition of Rituximab to the HCVAD regimen appears to obviate the need for additional consolidative auto-PBSCT. (Romaguera, ASH 2005) In a retrospective analysis of patients treated at the University of Pennsylvania between 1999 and 2006, we seek to compare patients receiving the R-HCVAD regimen without transplant to those who received auto-PBSCT in the same time period. Patients were stratified by their transplant status. Survival data, disease status, and secondary malignancy information were assessed. Twenty-five patients were identified, with an age range of 41–76 years at diagnosis. All but one patient had advanced disease at diagnosis (stage III or IV) There were 18 men and 7 women. 17 patients received R-HCVAD alone, and 8 patients went on to Cyclophosphamide/TBI autologous stem cell transplant. Survival in the patients treated with R-HCVAD alone was 82.3% with a median follow-up of 3 years, with all deaths due to progressive disease. Of surviving patients in this group, 1 out of 14 has had additional therapy but remains in second complete remission. Survival of patients post-transplant was 75%, with one death due to disease and one death due to secondary malignancy (lung cancer). One additional case of secondary MDS was also reported in the transplant group. In summary, our series reveals that the R-HCVAD therapy can provide excellent long-term remission rates with no additional survival advantage gained from autologous transplant. An increased risk for secondary malignancies was observed in patients undergoing autologous PBSCT. Further prospective studies of consolidative therapy are warranted in this population.