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

Christian W Eskelund; Arne Kolstad; Mats Jerkeman; Riikka Räty; Anna Laurell; Sandra Eloranta; Karin E Smedby; Simon Husby; Lone B Pedersen; Niels S Andersen; Mikael Eriksson; Eva Kimby; Hans Bentzen; Outi Kuittinen; Grete F Lauritzsen; Herman Nilsson-Ehle; Elisabeth Ralfkiaer; Mats Ehinger; Christer Sundström; Jan Delabie; Marja-Liisa Karjalainen-Lindsberg; Christopher T Workman; Christian Garde; Erkki Elonen; Peter Brown; Kirsten Grønbaek; Christian H Geisler

doi:10.1111/bjh.14241

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

Christian W Eskelund, Arne Kolstad, Mats Jerkeman, Riikka Räty, Anna Laurell, Sandra Eloranta, Karin E Smedby, Simon Husby, Lone B Pedersen, Niels S Andersen, Mikael Eriksson, Eva Kimby, Hans Bentzen, Outi Kuittinen, Grete F Lauritzsen, Herman Nilsson-Ehle, Elisabeth Ralfkiaer, Mats Ehinger, Christer Sundström, Jan DelabieMarja-Liisa Karjalainen-Lindsberg, Christopher T Workman, Christian Garde, Erkki Elonen, Peter Brown, Kirsten Grønbaek, Christian H Geisler

Department of Clinical Medicine

98 Citations (Scopus)

Abstract

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.

Original language	English
Journal	British Journal of Haematology
Volume	175
Issue number	3
Pages (from-to)	410-418
Number of pages	9
ISSN	0007-1048
DOIs	https://doi.org/10.1111/bjh.14241
Publication status	Published - 1 Nov 2016

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Eskelund, C. W., Kolstad, A., Jerkeman, M., Räty, R., Laurell, A., Eloranta, S., Smedby, K. E., Husby, S., Pedersen, L. B., Andersen, N. S., Eriksson, M., Kimby, E., Bentzen, H., Kuittinen, O., Lauritzsen, G. F., Nilsson-Ehle, H., Ralfkiaer, E., Ehinger, M., Sundström, C., ... Geisler, C. H. (2016). 15-year follow-up of the Second Nordic Mantle Cell Lymphoma trial (MCL2): prolonged remissions without survival plateau. British Journal of Haematology, 175(3), 410-418. https://doi.org/10.1111/bjh.14241

Eskelund, CW, Kolstad, A, Jerkeman, M, Räty, R, Laurell, A, Eloranta, S, Smedby, KE, Husby, S, Pedersen, LB, Andersen, NS, Eriksson, M, Kimby, E, Bentzen, H, Kuittinen, O, Lauritzsen, GF, Nilsson-Ehle, H, Ralfkiaer, E, Ehinger, M, Sundström, C, Delabie, J, Karjalainen-Lindsberg, M-L, Workman, CT, Garde, C, Elonen, E, Brown, P , Grønbaek, K & Geisler, CH 2016, '15-year follow-up of the Second Nordic Mantle Cell Lymphoma trial (MCL2): prolonged remissions without survival plateau', British Journal of Haematology, vol. 175, no. 3, pp. 410-418. https://doi.org/10.1111/bjh.14241

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

abstract = "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.",

author = "Eskelund, {Christian W} and Arne Kolstad and Mats Jerkeman and Riikka R{\"a}ty and Anna Laurell and Sandra Eloranta and Smedby, {Karin E} and Simon Husby and Pedersen, {Lone B} and Andersen, {Niels S} and Mikael Eriksson and Eva Kimby and Hans Bentzen and Outi Kuittinen and Lauritzsen, {Grete F} and Herman Nilsson-Ehle and Elisabeth Ralfkiaer and Mats Ehinger and Christer Sundstr{\"o}m and Jan Delabie and Marja-Liisa Karjalainen-Lindsberg and Workman, {Christopher T} and Christian Garde and Erkki Elonen and Peter Brown and Kirsten Gr{\o}nbaek and Geisler, {Christian H}",

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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

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 -

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

Abstract

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