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Addition of bortezomib to standard dose chop chemotherapy improves response and survival in relapsed mantle cell lymphoma
Author(s) -
Furtado Michelle,
Johnson Rod,
Kruger Anton,
Turner Deborah,
Rule Simon
Publication year - 2015
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.13101
Subject(s) - bortezomib , chop , medicine , vincristine , mantle cell lymphoma , chemotherapy , gastroenterology , lymphoma , oncology , cyclophosphamide , multiple myeloma
Summary The proteasome inhibitor, bortezomib, potentially increases cell sensitivity to chemotherapy. This study was performed to determine the overall response rate ( ORR ), overall survival ( OS ), progression‐free survival ( PFS ) and toxicity of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone) compared to CHOP + bortezomib chemotherapy in mantle cell lymphoma ( MCL ) patients at first relapse. Forty‐six patients were randomly assigned to standard dose CHOP ± bortezomib 1·6 mg/m 2 given on a 21‐d cycle for up to eight cycles of treatment. Median age was 71 years ( CHOP arm) and 69 years ( CHOP ‐bortezomib arm). Median Eastern Cooperative Oncology Group performance status was 1 ( CHOP ) and 0 ( CHOP ‐bortezomib) with 65% and 52%, respectively, having a disease stage of IV . ORR was 47·8% ( CHOP ) and 82·6% ( CHOP ‐bortezomib). Complete response rate was 21·7% ( CHOP ) vs. 34·8% ( CHOP ‐bortezomib); partial response rate was 26·1% ( CHOP ) vs. 47·8% ( CHOP ‐bortezomib). Median OS was 11·8 months ( CHOP ) and 35·6 months ( CHOP ‐bortezomib) ( P = 0·01, Hazard ratio [ HR ] 0·37 [95% confidence interval ( CI ) 0·16–0·83)] and there was a non‐significant improvement in PFS : 8·1 months ( CHOP ) and 16·5 months ( CHOP ‐bortezomib) [ P = 0·12, HR 0·60 (95% CI 0·31–1·15)]. Severe (≥grade 3) sensory neuropathy was similar in both arms (4·3% CHOP vs. 6·5% CHOP ‐bortezomib). We conclude that the addition of bortezomib to CHOP chemotherapy for relapsed MCL significantly improves outcome with a manageable increase in toxicity.