Dr. Gerson on Strategies Aimed at Alleviating Toxicity in Older Patients With MCL

James N. Gerson, MD, assistant professor of clinical medicine, Perelman School of Medicine, University of Pennsylvania, discusses strategies aimed at alleviating toxicity in older patients with mantle cell lymphoma (MCL).

Most elderly patients with MCL are not candidates for transplant, says Gerson. Rather, these patients are often treated with bendamustine-based therapies, typically bendamustine and rituximab (Rituxan; BR). Recently, the phase III LYM-3002 trial comparing VR-CAP (bortezomib [Velcade], rituximab, cyclophosphamide, doxorubicin, and prednisone) with R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisolone) demonstrated a significant improvement in the VR-CAP arm in transplant-ineligible patients. At a median follow-up of 82 months, median overall survival was 90.7 months in the VR-CAP arm versus 55.7 months in the R-CHOP arm (HR, 0.66; 95% CI, 0.51-0.85; P =.001). Accordingly, Gerson commonly uses VR-CAP in transplant-ineligible patients; however, BR can be used as an alternative for older patients who cannot tolerate an anthracycline.

In elderly patients who have a limited volume of asymptomatic disease, rituximab monotherapy may also suffice, concludes Gerson.