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Oral Arsenic Trioxide-Based Regimen as Salvage Treatment for Relapsed or Refractory Mantle-Cell Lymphoma

Oral arsenic trioxide (ATO) was originally developed for the treatment of relapsed acute promyelocytic leukemia.1 In this study, Gill and colleagues investigated the use of an oral ATO-based regimen for patients with relapsed or refractory mantle-cell lymphoma (MCL). A total of 39 patients with relapsed or refractory MCL who were ineligible for high-dose chemotherapy were enrolled in the study. The patients’ median age was 64 years and they had received a median of 2 previous MCL treatment regimens. All patients were treated with a continuous oral regimen that included oral ATO, chlorambucil, and ascorbic acid.

The overall response rate to the oral 3-drug combination was 49%; 28% of patients achieved complete response and 21% of patients achieved partial response. Independent prognostic factors for response included increased lactate dehydrogenase and unfavorable MIPI (Mantle-Cell Lymphoma International Prognostic Index). At a median follow up of 21 months, the median progression-free survival (PFS) was 16 months and the median overall survival (OS) was 38 months. The 2-year and 5-year PFS were 41% and 29%, respectively. The 2-year and 5-year OS were 56% and 43%, respectively. Only grade 1 and grade 2 toxicities were observed, including hematologic toxicity (56%) and hepatic toxicity (8%).

Independent prognostic factors for PFS were female gender, ECOG (Eastern Cooperative Oncology Group) performance score of 2, and nonresponse to treatment. Independent prognostic factors for OS were female gender, ECOG performance score of 2, nonresponse to treatment, and disease progression during treatment.

These findings suggest that the oral combination regimen of ATO, chlorambucil, and ascorbic acid is effective with minimal toxicity in patients with relapsed or refractory MCL.


  1. Iland HJ, Seymour JF, Wei A. Optimal approach for high-risk acute promyelocytic leukemia. Curr Opin Hematol. 2014;21(2):102-113.
  2. Gill H, Au W, Cheung WW, Kwong YL. Oral arsenic trioxide based regimen as salvage treatment for relapsed or refractory mantle cell lymphoma. Blood. 2013;122. Abstract 4346.
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Last modified: August 30, 2021