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

Eskelund, Christian W. ; Kolstad, Arne ; Jerkeman, Mats LU ; Räty, Riikka ; Laurell, Anna LU ; Eloranta, Sandra ; Smedby, Karin E. ; Husby, Simon ; Pedersen, Lone B. and Andersen, Niels S. , et al. (2016) In British Journal of Haematology 175(3). p.410-418
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,... (More)

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.

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@article{03cf2745-80c5-488b-810b-5646c7f75750,
  abstract     = {{<p>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.</p>}},
  author       = {{Eskelund, Christian W. and Kolstad, Arne and Jerkeman, Mats and Räty, Riikka and Laurell, Anna and Eloranta, Sandra and Smedby, Karin E. and Husby, Simon and Pedersen, Lone B. and Andersen, Niels S. and Eriksson, Mikael and Kimby, Eva and Bentzen, Hans and Kuittinen, Outi and Lauritzsen, Grete F. and Nilsson-Ehle, Herman and Ralfkiær, Elisabeth and Ehinger, Mats and Sundström, Christer and Delabie, Jan and Karjalainen-Lindsberg, Marja Liisa and Workman, Christopher T. and Garde, Christian and Elonen, Erkki and Brown, Peter and Grønbæk, Kirsten and Geisler, Christian H.}},
  issn         = {{0007-1048}},
  keywords     = {{Clinical trials; High dose therapy; Mantle Cell Lymphoma; Non-Hodgkin Lymphoma}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{410--418}},
  publisher    = {{Blackwell}},
  series       = {{British Journal of Haematology}},
  title        = {{15-year follow-up of the Second Nordic Mantle Cell Lymphoma trial (MCL2) : Prolonged remissions without survival plateau}},
  url          = {{http://dx.doi.org/10.1111/bjh.14241}},
  doi          = {{10.1111/bjh.14241}},
  volume       = {{175}},
  year         = {{2016}},
}