Bortezomib (Velcade), Rituximab, Cyclophosphamide, and Dexamethasone Combination Regimen Is Active as Front-Line Therapy of Low-Grade Non-Hodgkin Lymphoma

ObjectiveTo evaluate the efficacy and toxicity of the combination of VRCD (velcade/rituximab/cyclophosphamide/dexamethasone) in chemotherapy-naïve low-grade non-Hodgkin lymphoma or patients with transplantation-ineligible mantle cells.MethodsThe patients were treated with velcade, at 1.6 mg/m2, on days 1, 8, 15, and 22 on every 35-day cycle. Rituximab was given at 375 mg/m2 on the same days as velcade during cycle 1 and then only on day 1 in subsequent cycles. Dexamethasone was given orally at 40 mg on days 1, 2, 8, 9, 15, 16, 22, and 23. Cyclophosphamide was administered orally at 400 mg/m2 on days 1-4. The patients had to meet criteria to initiate therapy and had to demonstrate adequate performance status and organ function.ResultsTwelve patients were enrolled, after which the study was closed due to a lack of funding. The median age was 68 years (37-83 years), with 83% having stage III/IV disease. Five patients had marginal zone, 4 had follicular, 2 had small lymphocytic, and 1 had mantle cell histologies. The overall response rate was 90% (complete response, 54%). At a median follow-up of 22 months, 9 (75%) patients remain alive, and the median time to progression has not been reached. A third of the patients required dose reductions after a median of 6.5 cycles. No grade 3 or 4 peripheral neuropathy was witnessed.ConclusionsAlthough the number of studied patients is small, VRCD appears safe and active as front-line therapy for low-grade non-Hodgkin lymphoma. Further studies are justified.