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Standardized treatments for indolent B cell lymphoma primarily consisting of follicular lymphoma (FL) and for mantle cell lymphoma (MCL) have yet to be established. Here the Hokuriku Hematology Oncology Study Group conducted a multicenter prospective study to investigate the efficacy and safety of a combination regimen of rituximab, cladribine, mitoxantrone, and dexamethasone (R-CMD) in indolent B cell lymphoma and MCL. A total of 33 CD20-positive patients who received care between January 2008 and August 2011 were investigated. These patients’ illnesses were FL ( n  = 21), nodal marginal zone B cell lymphoma (NMZB,  n  = 3), MCL ( n  = 3), splenic marginal zone B cell lymphoma ( n  = 2), hairy cell leukemia ( n  = 1), Waldenstrom macroglobulinemia (WM,  n  = 1), and lymphoplasmacytic lymphoma (LPL,  n  = 2). Patients received four 21-day cycles of rituximab 375 mg/m 2  (day 1), cladribine 0.10 mg/kg (days 1–3), mitoxantrone 8 mg/m 2  (day 1), and dexamethasone 8 mg/body (days 1–3), with four additional rituximab doses at 4-week intervals. Of the 33 patients, 26 achieved complete response/unconfirmed complete response, and six achieved a partial response (4 with FL, 1 with NMZB, 1 with WM). One had progressive disease (FL), and four relapsed after remission (1 with FL, 2 with MCL, 1 with LPL). R-CMD therapy was relatively convenient and effective in indolent B cell lymphoma and MCL. Nonetheless, to suppress the number and function of both B cells and T cells, comprehensive infection prevention and follow-up are necessary in the future.

Prospective clinical study of R-CMD therapy for indolent B cell lymphoma and mantle cell lymphoma from the Hokuriku Hematology Oncology Study Group