title: Early consolidation by myeloablative radiochemotherapy followed by autologous stem cell transplantation in first remission significantly prolongs progression-free survival in mantle-cell lymphoma: results of a prospective randomized trial of the European MCL Network.
abstract: Mantle-cell lymphoma (MCL) is characterized by poor prognosis with a median survival of only 3 to 4 years. To improve clinical outcome, the European MCL Network initiated a randomized trial comparing consolidation with myeloablative radiochemotherapy followed by autologous stem cell transplantation (ASCT) to alpha-interferon maintenance (IFN alpha) in first remission. Patients 65 years of age or younger with advanced-stage MCL were assigned to ASCT or IFN alpha after achievement of complete or partial remission by a cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)-like induction therapy. According to the International Prognostic Index (IPI), 43% of patients had a low-risk, 41% a low-intermediate, 11% a high-intermediate, and 6% a high-risk profile. Sixty-two of 122 patients proceeded to ASCT and 60 received IFN alpha. Patients in the ASCT arm experienced a significantly longer progression-free survival (PFS) with a median of 39 months compared with 17 months for patients in the IFN alpha arm (P = .0108). The 3-year overall survival (OS) was 83% after ASCT versus 77% in the IFN group (P = .18). Early consolidation by myeloablative radiochemotherapy followed by ASCT is feasible and results in a significant prolongation of PFS in advanced-stage MCL. Longer follow-up is needed to determine the effect on OS.
authors.affiliation: Department of Internal Medicine III, Ludwig-Maximilians University, Marchioninistrasse 15, 81377 Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Dreyling
authors.forename: Georg
authors.initials: G
authors.lastname: Lenz
authors.forename: Eva
authors.initials: E
authors.lastname: Hoster
authors.forename: Achiel
authors.initials: A
authors.lastname: Van Hoof
authors.forename: Christian
authors.initials: C
authors.lastname: Gisselbrecht
authors.forename: Rudolf
authors.initials: R
authors.lastname: Schmits
authors.forename: Bernd
authors.initials: B
authors.lastname: Metzner
authors.forename: Lorenz
authors.initials: L
authors.lastname: Truemper
authors.forename: Marcel
authors.initials: M
authors.lastname: Reiser
authors.forename: Hjalmar
authors.initials: H
authors.lastname: Steinhauer
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Boiron
authors.forename: Marc A
authors.initials: MA
authors.lastname: Boogaerts
authors.forename: Ali
authors.initials: A
authors.lastname: Aldaoud
authors.forename: Vittorio
authors.initials: V
authors.lastname: Silingardi
authors.forename: Hanneke C
authors.initials: HC
authors.lastname: Kluin-Nelemans
authors.forename: Joerg
authors.initials: J
authors.lastname: Hasford
authors.forename: Reza
authors.initials: R
authors.lastname: Parwaresch
authors.forename: Michael
authors.initials: M
authors.lastname: Unterhalt
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hiddemann
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000009:adverse effects; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage* / Q000009:adverse effects; D005060:Europe; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D020522:Lymphoma, Mantle-Cell / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage* / Q000009:adverse effects; D012074:Remission Induction; D016019:Survival Analysis; D014182:Transplantation, Autologous; D014750:Vincristine / Q000008:administration & dosage* / Q000009:adverse effects; D014916:Whole-Body Irradiation
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone