Mantle cell lymphoma: non-myeloablative versus dose-intensive therapy

Mantle cell lymphoma (MCL) is now recognized as an aggressive lymphoma, in which there is frequent development of resistance to chemotherapy and a median survival period of 3-4 years. In recent years, the use of the chimeric monoclonal antibody rituximab, which is directed against the CD20 antigen, has provided new possibilities for the treatment of MCL. Rituximab alone produces overall response rates of 30-33% in patients with MCL, and is also effective at inducing complete responses in combination with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone). Furthermore, the addition of rituximab to the regimen of fractionated Hyper-CVAD/MTX-AraC (cyclophosphamide/doxorubicin:vincristine/dexamethasone alternated with methotrexate/cytarabine) has been found to produce responses and relapse-free and overall survival in younger patients that are comparable to those seen with Hyper-CVAD/MTX-AraC plus stem cell transplantation. Despite these promising results, patients aged > 65 years have a poor prognosis, and further studies are required to improve outcomes in this population.