Nordic MCL2 trial update: six-year follow-up after intensive immunochemotherapy for untreated mantle cell lymphoma followed by BEAM or BEAC + autologous stem-cell support: still very long survival but late relapses do occur.
Mantle cell lymphoma (MCL) is a heterogenic non-Hodgkin lymphoma entity, with a median survival of about 5 years. In 2008 we reported the early - based on the median observation time of 4 years - results of the Nordic Lymphoma Group MCL2 study of frontline intensive induction immunochemotherapy and autologous stem cell transplantation (ASCT), with more than 60% event-free survival at 5 years, and no subsequent relapses reported. Here we present an update after a median observation time of 6·5 years. The overall results are still excellent, with median overall survival and response duration longer than 10 years, and a median event-free survival of 7·4 years. However, six patients have now progressed later than 5 years after end of treatment. The international MCL Prognostic Index (MIPI) and Ki-67-expression were the only independent prognostic factors. Subdivided by the MIPI-Biological Index (MIPI + Ki-67, MIPI-B), more than 70% of patients with low-intermediate MIPI-B were alive at 10 years, but only 23% of the patients with high MIPI-B. These results, although highly encouraging regarding the majority of the patients, underline the need of a risk-adapted treatment strategy for MCL. The study was registered at www.isrctn.org as ISRCTN 87866680.
Rigshospitalet, Copenhagen, Denmark. christian.geisler@rh.regionh.dk
Christian H
CH
Geisler
Arne
A
Kolstad
Anna
A
Laurell
Mats
M
Jerkeman
Riikka
R
Räty
Niels S
NS
Andersen
Lone B
LB
Pedersen
Mikael
M
Eriksson
Marie
M
Nordström
Eva
E
Kimby
Hans
H
Bentzen
Outi
O
Kuittinen
Grete F
GF
Lauritzsen
Herman
H
Nilsson-Ehle
Elisabeth
E
Ralfkiaer
Mats
M
Ehinger
Christer
C
Sundström
Jan
J
Delabie
Marja-Liisa
ML
Karjalainen-Lindsberg
Peter
P
Brown
Erkki
E
Elonen
D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002330:Carmustine / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007167:Immunotherapy; D020522:Lymphoma, Mantle-Cell / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D011034:Podophyllotoxin / Q000008:administration & dosage; D011379:Prognosis; D012008:Recurrence; D000069283:Rituximab; D015996:Survival Rate; D014182:Transplantation, Autologous
D058846:Antibodies, Monoclonal, Murine-Derived; D003561:Cytarabine; D000069283:Rituximab; D005047:Etoposide; D003520:Cyclophosphamide; D011034:Podophyllotoxin; D008558:Melphalan; D002330:Carmustine