Correspondence:

There is currently no international consensus for first-line treatment (prior to autologous stem cell transplantation) in mantle cell lymphoma patients. Here, we investigated the efficacy and tolerance of VAD associated with chlorambucil (VAD+C) and rituximab or not before autolo-gous stem cell transplantation. Design and Methods Between 1996 and 2005, 113 previously untreated mantle cell lymphoma patients were enrolled in two consecutive prospective phase II studies. Responses and response factors to the (R)VAD+C regimen were evaluated. The survival prognostic value of the MIPI score and Ki67 were also analyzed. Results The induction phase of 4 courses of (R)VAD+C showed very low hematologic and extra-hema-tologic toxicity (grade 3-4 thrombopenia and neutropenia, 9 % and 2.7%, respectively and grade 3-4 extra-hematologic toxicities, 1.6%). Overall and complete response rates were 73% and 46%, respectively, and rose to 83 % and 51 % for the 70 % of patients with less than two independent response factors (LDH, B symptoms and lymphocytosis). At the end of treatment