15-year follow-up of the Second Nordic Mantle Cell Lymphoma trial (MCL2): prolonged remissions without survival plateau

TY - JOUR

T1 - 15-year follow-up of the Second Nordic Mantle Cell Lymphoma trial (MCL2)

T2 - prolonged remissions without survival plateau

AU - Eskelund, Christian W

AU - Kolstad, Arne

AU - Jerkeman, Mats

AU - Räty, Riikka

AU - Laurell, Anna

AU - Eloranta, Sandra

AU - Smedby, Karin E

AU - Husby, Simon

AU - Pedersen, Lone B

AU - Andersen, Niels S

AU - Eriksson, Mikael

AU - Kimby, Eva

AU - Bentzen, Hans

AU - Kuittinen, Outi

AU - Lauritzsen, Grete F

AU - Nilsson-Ehle, Herman

AU - Ralfkiaer, Elisabeth

AU - Ehinger, Mats

AU - Sundström, Christer

AU - Delabie, Jan

AU - Karjalainen-Lindsberg, Marja-Liisa

AU - Workman, Christopher T

AU - Garde, Christian

AU - Elonen, Erkki

AU - Brown, Peter

AU - Grønbaek, Kirsten

AU - Geisler, Christian H

N1 - © 2016 John Wiley & Sons Ltd.

PY - 2016/11/1

Y1 - 2016/11/1

N2 - In recent decades, the prognosis of Mantle Cell Lymphoma (MCL) has been significantly improved by intensified first-line regimens containing cytarabine, rituximab and consolidation with high-dose-therapy and autologous stem cell transplantation. One such strategy is the Nordic MCL2 regimen, developed by the Nordic Lymphoma Group. We here present the 15-year updated results of the Nordic MCL2 study after a median follow-up of 11·4 years: For all patients on an intent-to-treat basis, the median overall and progression-free survival was 12·7 and 8·5 years, respectively. The MCL International Prognostic Index (MIPI), biological MIPI, including Ki67 expression (MIPI-B) and the MIPI-B including mIR-18b expression (MIPI-B-miR), in particular, significantly divided patients into distinct risk groups. Despite very long response durations of the low and intermediate risk groups, we observed a continuous pattern of relapse and the survival curves never reached a plateau. In conclusion, despite half of the patients being still alive and 40% in first remission after more than 12 years, we still see an excess disease-related mortality, even among patients experiencing long remissions. Even though we consider the Nordic regimen as a very good choice of regimen, we recommend inclusion in prospective studies to explore the benefit of novel agents in the frontline treatment of MCL.

AB - In recent decades, the prognosis of Mantle Cell Lymphoma (MCL) has been significantly improved by intensified first-line regimens containing cytarabine, rituximab and consolidation with high-dose-therapy and autologous stem cell transplantation. One such strategy is the Nordic MCL2 regimen, developed by the Nordic Lymphoma Group. We here present the 15-year updated results of the Nordic MCL2 study after a median follow-up of 11·4 years: For all patients on an intent-to-treat basis, the median overall and progression-free survival was 12·7 and 8·5 years, respectively. The MCL International Prognostic Index (MIPI), biological MIPI, including Ki67 expression (MIPI-B) and the MIPI-B including mIR-18b expression (MIPI-B-miR), in particular, significantly divided patients into distinct risk groups. Despite very long response durations of the low and intermediate risk groups, we observed a continuous pattern of relapse and the survival curves never reached a plateau. In conclusion, despite half of the patients being still alive and 40% in first remission after more than 12 years, we still see an excess disease-related mortality, even among patients experiencing long remissions. Even though we consider the Nordic regimen as a very good choice of regimen, we recommend inclusion in prospective studies to explore the benefit of novel agents in the frontline treatment of MCL.

U2 - 10.1111/bjh.14241

DO - 10.1111/bjh.14241

M3 - Journal article

C2 - 27378674

SN - 0007-1048

VL - 175

SP - 410

EP - 418

JO - British Journal of Haematology

JF - British Journal of Haematology

IS - 3

ER -