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Pre-Emptive Treatment With Rituximab of Molecular Relapse After Autologous Stem Cell Transplantation in Mantle Cell Lymphoma.

Andersen, Niels S; Pedersen, Lone B; Laurell, Anna; Elonen, Erkki; Kolstad, Arne; Boesen, Anne Marie; Pedersen, Lars M; Lauritzsen, Grete F; Ekanger, Roald and Nilsson-Ehle, Herman, et al. (2009) In Journal of Clinical Oncology 27. p.4365-4370
Abstract
PURPOSE: Minimal residual disease (MRD) is predictive of clinical progression in mantle-cell lymphoma (MCL). According to the Nordic MCL-2 protocol we prospectively analyzed the efficacy of pre-emptive treatment using rituximab to MCL patients in molecular relapse after autologous stem cell transplantation (ASCT). Patients and Materials: MCL patients enrolled in the study, who had polymerase chain reaction (PCR) detectable molecular markers and underwent ASCT, were followed with serial PCR assessments of MRD in consecutive bone marrow and peripheral blood samples after ASCT. In case of molecular relapse with increasing MRD levels, patients were offered pre-emptive treatment with rituximab 375 mg/m(2) weekly for 4 weeks. RESULTS: Of 160 MCL... (More)
PURPOSE: Minimal residual disease (MRD) is predictive of clinical progression in mantle-cell lymphoma (MCL). According to the Nordic MCL-2 protocol we prospectively analyzed the efficacy of pre-emptive treatment using rituximab to MCL patients in molecular relapse after autologous stem cell transplantation (ASCT). Patients and Materials: MCL patients enrolled in the study, who had polymerase chain reaction (PCR) detectable molecular markers and underwent ASCT, were followed with serial PCR assessments of MRD in consecutive bone marrow and peripheral blood samples after ASCT. In case of molecular relapse with increasing MRD levels, patients were offered pre-emptive treatment with rituximab 375 mg/m(2) weekly for 4 weeks. RESULTS: Of 160 MCL patients enrolled, 145 underwent ASCT, of whom 78 had a molecular marker. Of these, 74 were in complete remission (CR) and four had progressive disease after ASCT. Of the CR patients, 36 underwent a molecular relapse up to 6 years (mean, 18.5 months) after ASCT. Ten patients did not receive pre-emptive treatment mainly due to a simultaneous molecular and clinical relapse, while 26 patients underwent pre-emptive treatment leading to reinduction of molecular remission in 92%. Median molecular and clinical relapse-free survival after pre-emptive treatment were 1.5 and 3.7 years, respectively. Of the 38 patients who remain in molecular remission for now for a median of 3.3 years (range, 0.4 to 6.6 years), 33 are still in clinical CR. CONCLUSION: Molecular relapse may occur many years after ASCT in MCL, and PCR based pre-emptive treatment using rituximab is feasible, reinduce molecular remission, and may prevent clinical relapse. (Less)
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Journal of Clinical Oncology
volume
27
pages
4365 - 4370
publisher
American Society of Clinical Oncology
external identifiers
  • wos:000269652200023
  • pmid:19652064
  • scopus:70349331498
ISSN
1527-7755
DOI
10.1200/JCO.2008.21.3116
language
English
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yes
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989aa43d-8769-4350-9b74-1ab1fb57b3d0 (old id 1470104)
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http://www.ncbi.nlm.nih.gov/pubmed/19652064?dopt=Abstract
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2009-09-04 11:11:21
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2017-11-12 04:09:03
@article{989aa43d-8769-4350-9b74-1ab1fb57b3d0,
  abstract     = {PURPOSE: Minimal residual disease (MRD) is predictive of clinical progression in mantle-cell lymphoma (MCL). According to the Nordic MCL-2 protocol we prospectively analyzed the efficacy of pre-emptive treatment using rituximab to MCL patients in molecular relapse after autologous stem cell transplantation (ASCT). Patients and Materials: MCL patients enrolled in the study, who had polymerase chain reaction (PCR) detectable molecular markers and underwent ASCT, were followed with serial PCR assessments of MRD in consecutive bone marrow and peripheral blood samples after ASCT. In case of molecular relapse with increasing MRD levels, patients were offered pre-emptive treatment with rituximab 375 mg/m(2) weekly for 4 weeks. RESULTS: Of 160 MCL patients enrolled, 145 underwent ASCT, of whom 78 had a molecular marker. Of these, 74 were in complete remission (CR) and four had progressive disease after ASCT. Of the CR patients, 36 underwent a molecular relapse up to 6 years (mean, 18.5 months) after ASCT. Ten patients did not receive pre-emptive treatment mainly due to a simultaneous molecular and clinical relapse, while 26 patients underwent pre-emptive treatment leading to reinduction of molecular remission in 92%. Median molecular and clinical relapse-free survival after pre-emptive treatment were 1.5 and 3.7 years, respectively. Of the 38 patients who remain in molecular remission for now for a median of 3.3 years (range, 0.4 to 6.6 years), 33 are still in clinical CR. CONCLUSION: Molecular relapse may occur many years after ASCT in MCL, and PCR based pre-emptive treatment using rituximab is feasible, reinduce molecular remission, and may prevent clinical relapse.},
  author       = {Andersen, Niels S and Pedersen, Lone B and Laurell, Anna and Elonen, Erkki and Kolstad, Arne and Boesen, Anne Marie and Pedersen, Lars M and Lauritzsen, Grete F and Ekanger, Roald and Nilsson-Ehle, Herman and Nordström, Marie and Fredén, Susanne and Jerkeman, Mats and Eriksson, Mikael and Väärt, Jaan and Malmer, Beatrice and Geisler, Christian H},
  issn         = {1527-7755},
  language     = {eng},
  pages        = {4365--4370},
  publisher    = {American Society of Clinical Oncology},
  series       = {Journal of Clinical Oncology},
  title        = {Pre-Emptive Treatment With Rituximab of Molecular Relapse After Autologous Stem Cell Transplantation in Mantle Cell Lymphoma.},
  url          = {http://dx.doi.org/10.1200/JCO.2008.21.3116},
  volume       = {27},
  year         = {2009},
}