Frontline treatment with chemoimmunotherapy for limited-stage ocular adnexal MALT lymphoma with adverse factors: a phase II study
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Sung-Yong Kim1, Suk-Woo Yang2, Won-Sik Lee3, Jae Wook Yang4, Sung Yong Oh5, Hee Bae Ahn6, Deok-Hwan Yang7, Seong Kyu Park8, Jee Ho Chang9, Hyo Jung Kim10, Min Joung Lee11 and Seok-Goo Cho12
1Department of Hematology-Oncology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
2Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
3Department of Hematology and Oncology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
4Department of Ophthalmology, Busan Paik Hospital, Inje University, Busan, Korea
5Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
6Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea
7Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Jeollanamdo, Korea
8Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University, Bucheon, Korea
9Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University, Bucheon, Korea
10Division of Hematology-Oncology, Department of Internal Medicine, College of Medicine, Hallym University, Hallym University Sacred Heart Hospital, Anyang, Korea
11Department of Ophthalmology, College of Medicine, Hallym University, Hallym University Sacred Heart Hospital, Anyang, Korea
12Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
Seok-Goo Cho, email: firstname.lastname@example.org
Keywords: lymphoma, ocular, mucosa associated lymphoid tissue, rituximab, chemoimmunotherapy
Received: March 09, 2017 Accepted: June 24, 2017 Published: August 02, 2017
Background: Radiotherapy is a commonly used treatment for limited-stage ocular adnexal mucosa-associated lymphoid tissue lymphoma (OAML) but showed a substantial relapse risk if the disease involves beyond-conjunctiva or bilateral conjunctivae. Systemic chemoimmunotherapy may be an alternative frontline therapy for the limited disease with those adverse prognostic factors.
Patients and methods: We designed a multicenter, phase II study of the chemoimmunotherapy, rituximab, cyclophosphamide, vincristine, and prednisolone (R-CVP) for the treatment of patients with limited-stage OAML with bilateral or beyond-conjunctival involvement. Thirty-three patients with Ann Arbor stage I OAML with the adverse factors were enrolled. Patients received six cycles of R-CVP followed by two cycles of rituximab therapy.
Results: At the end of treatment, all the enrolled patients had responded. The cumulative complete response achievement was 93.9% at 2 years. At a median follow-up of 50.6 months, three patients had progressed. Progression-free survival and overall survival at 4 years was 90.3±5.3% and 100%, respectively.
Conclusions: This phase II study demonstrated durable efficacy of R-CVP chemoimmunotherapy, which has promise as an alternative frontline therapy for the limited-stage OAML patients with adverse prognostic factors.
Clinical trial registration: NCT01427114.
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