R-CHOP + R-HAD vs R-CHOP Followed by Maintenance Lenalidomide + Rituximab vs Rituximab for Older Patients With MCL

Exclusion Criteria

• •Female of childbearing potential
• •Any of the following laboratory abnormalities at diagnosis, if not related to lymphoma:
• •Absolute neutrophils count \<1,000 /mm3 Platelet count \< 75,000/mm3 AST/SGOT or ALT/SGPT \>3.0 UNL Serum total bilirubin \> 1.5 ULN (except if due to Gilbert's syndrome) Calculated creatinine clearance (Cockcroft-Gault formula or MDRD) \< 30 mL / min Central Nervous System involvement by lymphoma Contraindication for medical DVT prophylaxis for patients at high risk for DVT
• •Prior history of malignancies other than MCL unless the subject has been free of the disease for ≥ 5 years. Exceptions include the following:
• •Basal cell carcinoma or Squamous cell carcinoma of the skin
• •Carcinoma in situ of the cervix or of the breast
• •Incidental histologic finding of prostate cancer (TNM stage of T1a or T1b). Any serious medical condition, laboratory abnormality or psychiatric illness that would prevent the patient to receive the study medication as planned.
• •Seropositivity for human immunodeficiency virus at study entry Seropositivity for hepatitis C virus at study entry,
• •Active viral infection with hepatitis B virus at study entry:
• •HBsAg positive
• •HBsAg negative, anti-HBs positive and anti-HBc positive
• •Uncontrolled illness including, but not limited to:
• •Active infection requiring parenteral antibiotics.
• •Uncontrolled diabetes mellitus
• •Chronic symptomatic congestive heart failure (Class NYHA III or IV).
• •Unstable angina pectoris, angioplasty, stenting, or myocardial infarction within 6 months
• •Clinically significant cardiac arrhythmia that is symptomatic or requires treatment, or asymptomatic sustained ventricular tachycardia.
• •Prior ≥ Grade 3 allergic hypersensitivity to thalidomide. Prior ≥ Grade 3 rash or any desquamating (blistering) rash while taking thalidomide.
• •Known anti-murine antibody (HAMA) reactivity or known hypersensitivity to murine antibodies.
• •Subjects with ≥ Grade 2 neuropathy. Prior use of lenalidomide Participation in another clinical trial within three weeks before randomization in this study
• •Additional criteria for randomization in maintenance phase:
• •SD or PD after induction treatment determined as per Cheson 1999 criteria
• •Patient treated by induction immuno-chemotherapy other than 6-8 cycle of R-CHOP21 or 2-3 cycles of R-CHOP21 / 2-3 cycles of R-HAD28 (alternating)
• •Patients with serious underlying medical conditions, which could impair the ability to receive maintenance treatment
• •Calculated creatinine clearance of \< 30 mL / min
• •ANC is \< 1,000 cells/mm³
• •Platelet count is \< 50,000 cells/mm³