"Watch and wait" sometimes a viable option in mantle-cell lymphoma

NEW YORK (Reuters Health) - Although treatment immediately following diagnosis is common in patients with mantle-cell lymphoma (MCL), up to one-third of MCL cases may follow an indolent course, according to a retrospective analysis by U.S. researchers published online by the Journal of Clinical Oncology.

The analysis found no evidence that deferring treatment of asymptomatic patients with MCL led to any worse outcome. Remarkably, in the current study nearly half of those who did not require treatment in the first 3 months after diagnosis also did not require treatment for a least a year.

"If patients are asymptomatic, have relatively low tumor burden without current or impending organ compromise (for example, no bowel or genitourinary obstruction), and relatively normal laboratory values, we commonly will observe them for at least 3 months without treatment to monitor the pace and status of disease progression," Dr. John P. Leonard of Weill Cornell Medical College, New York, told Reuters Health.

"If the disease remains stable and non-progressive, and the patient remains asymptomatic," he added, "continued observation (with therapy deferred further) may be reasonable to consider."

The researchers noted that despite a recent trend toward aggressive early treatment of MCL, no randomized trials have shown an overall survival benefit advantage of one therapeutic approach over another.

Of 97 patients with MCL evaluated at Dr. Leonard's hospital between 1997 and 2007, 31 (32%) had been observed for more than 3 months before first receiving systemic therapy. Median time to treatment for these patients was 12 months (range 4-128 months), and the median follow-up was 55 months. There were no specific criteria for deferring initial treatment; this was at the discretion of the treating physician.

In both the delayed-treatment group and the early-treatment group, treatment was typically a CHOP-like regimen (cyclophosphamide, vincristine, doxorubicin and prednisone).

Dr. Leonard and his co-authors attribute the improved overall survival in the patients whose therapy was deferred to 2 factors. First, they tended to be younger than those who received immediate treatment, and second, they had better performance status at the time of diagnosis.

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