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 Workman, Christian Garde, Erkki Elonen, Peter Brown, Kirsten Grønbaek, Christian H. Geisler

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    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 languageEnglish
    JournalBritish Journal of Haematology
    Volume175
    Issue number3
    Pages (from-to)410–418
    Number of pages9
    ISSN0007-1048
    DOIs
    Publication statusPublished - 2016

    Keywords

    • Mantle Cell Lymphoma
    • Non-Hodgkin Lymphoma
    • Clinical trials
    • High dose therapy

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