Q & A with Dr. Peter Martin on High Dose Cytarabine for Mantle Cell Lymphoma Patients

In a recent interview with Clinical Advances in Hematology & Oncology, Dr. Peter Martin answered questions about the use of high dose cytarabine for patients with mantle cell lymphoma.

H&O How much does high-dose cytarabine improve patient outcome?

PM I do not think that has been very well defined. Not all of these data have sufficient long-term follow-up to comment on overall survival outcomes. Historically, patients were given R-CHOP followed by ASCT. The MCL-2 trial, published by Geisler and colleagues, added high-dose cytarabine and rituximab, and found that the outcomes were far superior in terms of progression-free survival and overall survival. However, these outcomes may not be solely due to high-dose cytarabine. Other explanations include the addition of rituximab, other changes in supportive care, and better pathology. Cytarabine may be part of that story, but it may not be the whole story.

The better trial to evaluate the potential role of cytarabine is the MCL Younger Trial that I mentioned earlier, which is a phase 3 trial published by Hermine and colleagues that compared 6 cycles of R-CHOP vs the R-CHOP/R-DHAP regimen. In this trial, the addition of R-DHAP seemed to reduce the risk of disease progression by approximately 30%. The study also found that the R-CHOP/R-DHAP regimen prepared people for ASCT better than R-CHOP alone.

A transcript of the full interview can be read here.

Dr. John Leonard Discusses How He Treats Mantle Cell Lymphoma

During the American Society of Hematology’s inaugural meeting on mantle cell lymphoma (MCL), Lymphoma Program Director, Dr. John Leonard discussed his treatment approach to patients with MCL. As TargetedOncology notes Dr. Leonard’s approach includes two key principles:

The first is to observe patients with asymptomatic MCL for as long as possible. In discussing the watch-and-wait approach, Leonard referred colleagues to data from the 2009 study that he co-authored in the Journal of Clinical Oncology, “Outcome of Deferred Initial Therapy in Mantle-Cell Lymphoma.”1 The overall survival (OS) of patients in the observation group exceeded that of patients in the early treatment group.

The second key principle that he suggested was to begin with less intensive initial treatments when needed due to their lower toxicity levels. “It’s true that less intensive treatments might have more chronic toxicity, but intensive treatments are unquestionably more toxic in the short term and can have longer-term toxicities as well,” he said.

You can read the rest of the article for a more in-depth summary of Dr. Leonard’s approach to treating patients with MCL.

Dr. John Leonard to Speak at ASH Meeting on Hematological Malignancies

This weekend at the ASH Meeting on Hematological Malignancies (ASHMHM15), Lymphoma Program Director, Dr. John Leonard will discuss how he treats patients with mantle cell lymphoma, and specifically on how to overcome mantle cell lymphoma resistance to ibrutinib.

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