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High‐dose Ara‐C and beam with autograft rescue in R‐CHOP responsive mantle cell lymphoma patients

Mantle cell lymphoma (MCL) has a dismal outcome when treated with conventional chemotherapy. This single arm phase 2 study evaluated intensive consolidation treatment of patients with newly diagnosed MCL up to the age of 65 years, responsive to R‐CHOP (rituximab, cyclophosphamide, oncovin, adriamycin, prednisolone). Endpoints for evaluation were toxicity, failure‐free survival (FFS) and overall survival (OS). Eighty‐seven patients were treated with three cycles of R–CHOP. Sixty‐six patients responded to R‐CHOP with at least a partial response, 62 continued protocol treatment with high‐dose cytarabine (Ara‐C; 2000 mg/m2, bid. over 4 d) and 61 patients received rituximab and stem cell harvest, followed by BEAM (carmustine, etoposide, Ara‐C, melphalan) and autologous stem cell rescue. Non‐haematological toxicity, grades III and IV, was seen in 8% of the patients after R‐CHOP, in 22% after high‐dose Ara‐C and in 55% after BEAM. The overall response rate was 70% (complete response rate 64%, partial response rate 6%), FFS and OS at 4 years were 36 ± 7% and 66 ± 6%, respectively. The FFS and OS at 4 years from the evaluation after BEAM in the 61 R‐CHOP responsive patients was 46 ± 9% and 79 ± 7%, respectively. In conclusion, high‐dose Ara‐C and BEAM with stem cell rescue in newly diagnosed MCL patients responsive to R‐CHOP is a manageable treatment with respect to toxicity. This regimen leads to long‐term, but probably not durable, remissions.