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

Abstract

SummaryMantle 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 eventfree 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.

Minimal residual disease in mantle cell lymphoma: insights into biology and impact on treatment

“…4 In the Nordic MCL2 study, after alternating R-CHOP/R-HA therapy and ASCT, the molecular remission rate was high with 92% in PB and/or BM. 3,33 In the Nordic MCL3 study, ASCT raised the percentage of MRDnegative patients in PB and/or BM from 53% after alternating R-CHOP/R-HA therapy to 83%. 25 In an interim analysis of the LYMA trial, ASCT increased MRD-negative rates among patients in clinical remission after 4 cycles of R-DHAP from 80% to 95% in PB and from 66% to 82% in BM.…”

Trends in incidence, treatment and survival of aggressive B-cell lymphoma in the Netherlands 1989-2010

“…[1][2][3][4] Second, the introduction of more intensive therapy in first-line treatment, including autologous stem cell transplantation (ASCT), improved OS of MCL and BL. [5][6][7][8][9] However, only a small selection of patients taken from the entire patient population typically takes part in randomized clinical trials. Particularly patients with comorbidities and age-related organ dysfunction are under-represented in clinical trials.…”

“…[5][6][7][8][9]22,64,65 The therapeutic goal in treating elderly NHL patients must be to maintain a balance between effective therapy and treatment toxicity. As patients over 65 years constitute around two-thirds of all patients with aggressive lymphoma, clinical trials for elderly 'frail' patients with no barrier for comorbidity are needed to determine appropriate therapy for these patients.…”

High dose cytarabine with rituximab is not enough in first-line treatment of mantle cell lymphoma with high proliferation: early closure of the Nordic Lymphoma Group Mantle Cell Lymphoma 5 trial

“…However, analysed according to the Mantle Cell Lymphoma International Prognostic Index (MIPI) [5] the outcome among high--risk patients was significantly inferior compared with low and intermediate risk [3], both in terms of response, response duration and of survival. Furthermore we identified high Ki--67 expression as the single most important prognostic factor [6].…”