Front-line treatment of mantle cell lymphoma.

In this issue of the Journal, Gressin et al. 1 publish the results of two phase II trials on newly diagnosed mantle cell lymphoma (MCL). In the first trial (LM1996), the treatment was infusion based vincristine and doxorubicin, oral dexamethasone and chlorambucil (VADC). Elderly patients received eight series while younger patients received six followed by high-dose melphalan and total-body irradiation with autologous stem cell transplantation (ASCT). In the subsequent LM2001 trial, younger patients (<65 years) received six cycles of VADC + rituximab (R-VADC) followed by ASCT. The reported outcome following VADC and R-VADC of all patients is about 45% complete response rate and an over 70% overall response rate. There was a significant progression free and overall survival advantage of ASCT (transplant was only offered to younger patients). Among transplanted patients, there is a trend for a progression free survival advantage of rituximab but no overall survival advantage. The results translate into median survival rates of less than three years for those who do not undergo transplant and seven years for those who do, both groups showing a continuing pattern of relapse and death with relapse occurring up to ten years after completion of therapy.