Management of mantle cell lymphoma in the elderly patient

Figures & data

Table 1 Ann Arbor classification

Stage	Definition
I
I	Involvement of a single lymph node region or
IE	a single extranodal site
II
II	Involvement of two or more lymph node regions on the same side of the diaphragm or
IIE	localized involvement of an extralymphatic site in combination with one or more lymph node regions on the same side of the diaphragm
III
III	Involvement of lymph node regions on both side of the diaphragm
IIIS	with infiltration of spleen or
IIIE	with localized involvement of an extralymphatic site or
IIIES	with infiltration of spleen and localized involvement of an extralymphatic site
IV	Diffuse or disseminated infiltration of one or more extralymphatic organs or tissues, with or without lymphadenopathy

Table 2 Overview of optional therapy choices for elderly patients with relapsed or refractory mantle cell lymphoma

Publication	Regimen	N	Responses	Median response duration	Median age (years)
Rummel et al^Citation36	BR (bendamustine, rituximab)	16	ORR 75% CR 50%	PFS 18 months	66
Weide et al^Citation38	BMR (bendamustine, mitoxantrone, rituximab)	18	ORR 77% CR 33%	PFS 21 months OS at 2 years 60%	66
Thomas et al^Citation39	FC (fludarabine, cyclophosphamide)	16	ORR 75% CR 56%	TTF 11 months	65
Forstpointner et al^Citation40	R-FCM (rituximab, fludarabine, cyclophosphamide, mitoxantrone)	24	ORR 58% CR 29%	PFS 8 months OS at 2 years 65%	65
Visco et al^Citation42	R-BAC (rituximab, bendamustine, cytarabine)	20	ORR 80% CR 70%	PFS at 2 years 70%	70
Inwards et al^Citation43	Cladribine	24	ORR 46% CR 21%	PFS 5.4 months OS at 2 years 36%	68
Fisher et al^Citation44	Bortezomib	155	ORR 33% CR 8%	DR 9.2 months OS not reached	65
Hess et al^Citation50	Temsirolimus	108	ORR 22% CR 2%	PFS 4.8 months OS 12.8 months	68
Habermann et al^Citation52	Lenalidomide	15	ORR 53% CR 20%	PFS 5.6 months DR 13.7 months	66
Weigert et al^Citation47	R-HAD + B (rituximab, cytarabine, dexamethasone, bortezomib)	8	ORR 50% CR 25%	PFS 5.5 months OS 15 months	65

Abbreviations: ORR, overall response rate; CR, complete response rate; PFS, progression-free survival; TTF, time to treatment failure; DR, duration of response; OS, overall survival.

RummelMJAl-BatranSEKimSZBendamustine plus rituximab is effective and has a favorable toxicity profile in the treatment of mantle cell and low-grade non-Hodgkin’s lymphomaJ Clin Oncol200523153383338915908650

 PubMed Web of Science ®Google Scholar

WeideRHessGKopplerHHigh anti-lymphoma activity of bendamustine/mitoxantrone/rituximab in rituximab pretreated relapsed or refractory indolent lymphomas and mantle cell lymphomas. A multicenter phase II study of the German Low Grade Lymphoma Study Group (GLSG)Leuk Lymphoma20074871299130617613757

 PubMed Web of Science ®Google Scholar

ThomasDWOwenRGJohnsonSASuperior quality and duration of responses among patients with mantle-cell lymphoma treated with fludarabine and cyclophosphamide with or without rituximab compared with prior responses to CHOPLeuk Lymphoma200546454955216019483

 PubMed Web of Science ®Google Scholar

ForstpointnerRDreylingMReppRThe addition of rituximab to a combination of fludarabine, cyclophosphamide, mitoxantrone (FCM) significantly increases the response rate and prolongs survival as compared with FCM alone in patients with relapsed and refractory follicular and mantle cell lymphomas: results of a prospective randomized study of the German Low-Grade Lymphoma Study GroupBlood2004104103064307115284112

 PubMed Web of Science ®Google Scholar

ViscoCFinottoSZambelloRCombination of rituximab, bendamustine, and cytarabine for patients with mantle-cell non-hodgkin lymphoma ineligible for intensive regimens or autologous transplantationJ Clin Oncol201331111442144923401442

 PubMed Web of Science ®Google Scholar

InwardsDJFishkinPAHillmanDWLong-term results of the treatment of patients with mantle cell lymphoma with cladribine (2-CDA) alone (95-80-53) or 2-CDA and rituximab (N0189) in the North Central Cancer Treatment GroupCancer2008113110811618470909

 PubMed Web of Science ®Google Scholar

FisherRIBernsteinSHKahlBSMulticenter Phase II study of bortezomib in patients with relapsed or refractory mantle cell lymphomaJ Clin Oncol200624304867487417001068

 PubMed Web of Science ®Google Scholar

HessGHerbrechtRRomagueraJPhase III study to evaluate temsirolimus compared with investigator’s choice therapy for the treatment of relapsed or refractory mantle cell lymphomaJ Clin Oncol200927233822382919581539

 PubMed Web of Science ®Google Scholar

HabermannTMLossosISJusticeGLenalidomide oral monotherapy produces a high response rate in patients with relapsed or refractory mantle cell lymphomaBr J Haematol2009145334434919245430

 PubMed Web of Science ®Google Scholar

WeigertOWeidmannEMueckRA novel regimen combining high dose cytarabine and bortezomib has activity in multiply relapsed and refractory mantle cell lymphoma – long-term results of a multicenter observation studyLeuk Lymphoma200950571672219347767

 PubMed Web of Science ®Google Scholar