TY - JOUR
T1 - Detailed Long-Term Follow-Up of Patients Who Relapsed After the Nordic Mantle Cell Lymphoma Trials
T2 - MCL2 and MCL3
AU - Eskelund, Christian Winther
AU - Dimopoulos, Kostas
AU - Kolstad, Arne
AU - Glimelius, Ingrid
AU - Räty, Riikka
AU - Gjerdrum, Lise Mette Rahbek
AU - Sonnevi, Kristina
AU - Josefsson, Pär
AU - Nilsson-Ehle, Herman
AU - Bentzen, Hans H N
AU - Fagerli, Unn Merete
AU - Kuittinen, Outi
AU - Haaber, Jacob
AU - Niemann, Carsten Utoft
AU - Pedersen, Lone Bredo
AU - Larsen, Maria Torp
AU - Geisler, Christian Hartmann
AU - Hutchings, Martin
AU - Jerkeman, Mats
AU - Grønbæk, Kirsten
N1 - Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/1
Y1 - 2021/1
N2 - Mantle cell lymphoma (MCL) is an incurable disease with a highly variable clinical course. The prognosis after relapse is generally poor, and no standard of care exists. We investigated the postrelapse outcomes of 149 patients who were initially treated in the Nordic Lymphoma Group trials, MCL2 or MCL3, both representing intensive cytarabine-containing frontline regimens including autologous stem cell transplant. Patients with progression of disease before 24 months (POD24, n = 51, 34%) displayed a median overall survival of 6.6 months compared with 46 months for patients with later POD (n = 98, 66%; P < 0.001). MCL international prognostic index, cell proliferation marker, blastoid morphology, and TP53 mutations showed independent prognostic value irrespective of POD24, and in a combined, exploratory risk score, patients with 0, 1, 2-3, or 4-5 high-risk markers, respectively, displayed a 5-year overall survival of 62%, 39%, 31%, and 0%. By a comparison of median progression-free survival of the different salvage therapies in the relapse setting, bendamustine-rituximab was superior to all other combination chemotherapy regimens; however, it was also associated with longer responses to last line of therapy. Collectively, we confirm the prognostic impact of POD24 and highlight the relevance of other biomarkers, and we emphasize the importance of novel therapies for patients with high-risk features at first POD.
AB - Mantle cell lymphoma (MCL) is an incurable disease with a highly variable clinical course. The prognosis after relapse is generally poor, and no standard of care exists. We investigated the postrelapse outcomes of 149 patients who were initially treated in the Nordic Lymphoma Group trials, MCL2 or MCL3, both representing intensive cytarabine-containing frontline regimens including autologous stem cell transplant. Patients with progression of disease before 24 months (POD24, n = 51, 34%) displayed a median overall survival of 6.6 months compared with 46 months for patients with later POD (n = 98, 66%; P < 0.001). MCL international prognostic index, cell proliferation marker, blastoid morphology, and TP53 mutations showed independent prognostic value irrespective of POD24, and in a combined, exploratory risk score, patients with 0, 1, 2-3, or 4-5 high-risk markers, respectively, displayed a 5-year overall survival of 62%, 39%, 31%, and 0%. By a comparison of median progression-free survival of the different salvage therapies in the relapse setting, bendamustine-rituximab was superior to all other combination chemotherapy regimens; however, it was also associated with longer responses to last line of therapy. Collectively, we confirm the prognostic impact of POD24 and highlight the relevance of other biomarkers, and we emphasize the importance of novel therapies for patients with high-risk features at first POD.
UR - http://www.scopus.com/inward/record.url?scp=85104140837&partnerID=8YFLogxK
U2 - 10.1097/HS9.0000000000000510
DO - 10.1097/HS9.0000000000000510
M3 - Journal article
C2 - 33364550
SN - 2572-9241
VL - 5
SP - 1
EP - 8
JO - HemaSphere
JF - HemaSphere
IS - 1
M1 - 510
ER -