Long-term safety and activity of cladribine in patients with extranodal B-cell marginal zone lymphoma of the mucosa-associated lymphoid tissue (MALT) lymphoma

About the author

Medical University of Vienna, Vienna, Austria

Markus Raderer undertook his early medical studies at the Medical University of Vienna, completing his residency in internal medicine between 1993 and 1999, specialising in haematology and oncology in 2001. He received the venia docendi for ‘Applied and Experimental Oncology’ and ‘Internal Medicine’ in 1999 and 2002, respectively. Professor Raderer is currently the Programme Director for Extranodal Lymphomas and for Endocrine Tumours at the Medical University of Vienna. He has been responsible for the management and conduct of phase II and III clinical trials at his institution since 1992.

Professor Raderer is on the Editorial Board of a number of journals including the Journal of Clinical Oncology, World Journal of Gastroenterology, and Middle European Journal of Medical Oncology. He has participated on consensus panels for the European Gastrointestinal Lymphoma Study Group (EGILS) on the topic of B-cell lymphoma of mucosa-associated lymphoid tissue, and the European Society of Medical Oncology (ESMO) on the subject of the management of lymphoid malignancies.

For a list of publications see http://www.ncbi.nlm.nih.gov/pubmed/?term=raderer+m

About the author

Barbara Kiesewetter, M.D.

Medical University of Vienna, Vienna, Austria

Barbara Kiesewetter undertook her early medical studies at the Medical University of Vienna. Currently she is doing her residency in internal medicine at the Clinical Division of Oncology, Department of Medicine I, Medical University of Vienna, and is a PhD student of the local doctoral program of “Applied Clinical Science”. Dr. Kiesewetter is part of the study group of Prof. Raderer (Extranodal Lymphomas and Endocrine Tumours) since 2010 and was involved in recent clinical trials and scientific work.

For a list of publications see http://www.ncbi.nlm.nih.gov/pubmed/?term=kiesewetter+b

Journal Reference

Hematol Oncol. 2015 Nov 18.

Kiesewetter B¹, Dolak W², Simonitsch-Klupp I³, Mayerhoefer ME⁴, Raderer M¹.

[expand title=”Show Affiliations”]

Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria.
Department of Internal Medicine III, Clinical Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
Department of Pathology, Medical University of Vienna, Vienna, Austria.
Department of Radiology, Medical University of Vienna, Vienna, Austria. [/expand]

Abstract

The purine analogue 2-chloro-deoxyadenosine (2-CDA, cladribine) +/- rituximab has been successfully tested in mucosa-associated lymphoid tissue lymphoma (MALT lymphoma) patients. However, studies using cladribine in other indications have reported the potential for prolonged hematological side effects and secondary hematologic and non-hematologic malignancies. To date, there have been no data on long-term effects of cladribine inMALT lymphoma patients. We have analyzed a large number of 49 patients treated with cladribine at our institution 1997-2011. All patients were treated within clinical trials and had undergone a standardized follow-up protocol minimizing a potential bias in the detection of late sequels and relapses. After a median follow-up time of 61 months (interquartile range: 43-72) for 49 analyzed patients, 35 (71%) are alive, while 14 (29%) have died. In the entire collective, three cases (6%) of prolonged pancytopenia including manifest myelodysplastic syndrome in one patient (2%), three cases (6%) of secondary lymphoid malignancies, and five cases (10%) of non-hematologic cancers were documented. In terms of outcome, 42/49 (86%) patients responded to cladribine-containing treatment, and only 10/42 (24%) responding patients needed further treatment after a median time to progression of 14 months (interquartile range, 8-34). Currently, 25/35 (71%) patients being alive are in ongoing complete remission and 2/35 (6%) in ongoing stable disease, respectively. Eight patients (23%) are free of lymphoma after second-line therapy, with the median overall survival not having been reached. Our data suggest that cladribine might be safely applied in patients with MALT lymphoma, also in terms of long-term toxicities. These data also confirm the potential of cladribine to induce durable remissions.

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Long-term safety and activity of cladribine in patients with extranodal B-cell marginal zone lymphoma of the mucosa-associated lymphoid tissue (MALT) lymphoma