International Journal of Hematology

DOI: 10.1532/IJH97.E0303 Pages: 155-158

Successful Salvage with High-Dose Sequential Chemotherapy Coupled with In Vivo Purging and Autologous Stem Cell Transplantation in 2 Patients with Primary Refractory Mantle Cell Lymphoma Presenting in the Leukemic Phase

1. Institute of Oncology, Hacettepe University School of Medicine, Sihhiye, Department of Medical Oncology and Hematopoietic Stem Cell Transplantation Unit

Correspondence to:
Esmin Kansu
Tel: 90-312-3052866
Fax: 90-312-3242009
Email: basakou@yahoo.com

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Abstract

We report the results of an aggressive salvage regimen in 2 patients with advanced-stage leukemic-phase mantle cell lymphoma who were refractory to previous conventional therapies.We combined multiple phases of a cytoreductive regimen including rituximab and sequential high-dose treatment with autologous stem cell transplantation (ASCT).The regimen consisted of a debulking phase with fludarabine, idarubicin, high-dose cytarabine, and high-dose methotrexate; a mobilization and in vivo purging phase with rituximab, cyclophosphamide, and granulocyte colony-stimulating factor; high-dose sequential chemotherapy with etoposide, mitoxantrone, and melphalan followed by ASCT; and, finally, posttransplantation consolidation with rituximab for treatment of minimal residual disease.With this regimen, these 2 refractory patients with multiple poor prognostic factors are in complete remission at 41 and 42 months following transplantation. Although the fact that these 2 patients are still in remission beyond 3 years after ASCT is encouraging, we need a longer follow-up to comment on their long-term survival.

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