In:
Blood, American Society of Hematology, Vol. 110, No. 11 ( 2007-11-16), p. LB1-LB1
Kurzfassung:
Mantle cell lymphoma (MCL) is considered incurable, with a median survival of 4 years. Intensive immunochemotherapy and autologous stem-cell (ASC) support has appeared promising in small patient cohorts, but has not been tested in large, consecutive series. Here we report the final results of the 2nd Nordic MCL (MCL2) trial after a median of 3 years follow-up from study entry. Methods: This unrandomized phase-II trial included 159 untreated patients younger than 66 years, 84% stage IV, 128 with classical, 31 with blastoid/pleomorphic cytology. Following 6 cycles of intensive induction immunochemotherapy with alternating cycles of rituximab (R) + maxi-CHOP and R+ high-dose AraC, responders received BEAM/BEAC with in-vivo purged (R) ASC support. Results: 153 patients (96%) responded to induction therapy with CR in 55% and PR in 41%. The 5-year event-free (EFS) and overall survival (OAS) are 63% and 74% respectively on intention-to-treat, and the 144 (91%) responders who completed treatment had 72% 5-year response duration, with plateaus emerging in all three curves at these levels. Figure Figure There were 6 treatment-related deaths (3,8%). Of 77 patients with available primers, 90% had become PCR-negative two months posttransplant; those who remained PCR-negative more than 1 year posttransplant had a significantly longer clinical response duration than patients who did not (P 〈 0.0001). Of 42 stem-cell products assessed 88% were PCR-negative as compared to only 12% in the MCL1 study (P 〈 0.001). In a multivariate analysis including age, sex, international prognostic index (IPI), cytological variants and Ki-67 proliferation index, only IPI and Ki-67 were independent predictors of EFS and response duration respectively, and only IPI and cytological variant of OAS. Compared to the 41 patients of 1st Nordic MCL study who received 4 cycles of maxi-CHOP without rituximab before BEAM or BEAC + ASCT (1), the OAS, EFS and response duration were highly significantly increased. Conclusion: The demonstration of long-term event-free survival in a large, consecutive prospective series now for the first time indicates that intensive immunochemotherapy including AraC and Rituximab with in-vivo purged stem-cell support may cure mantle cell lymphoma.
Materialart:
Online-Ressource
ISSN:
0006-4971
,
1528-0020
DOI:
10.1182/blood.V110.11.LB1.lb1
Sprache:
Englisch
Verlag:
American Society of Hematology
Publikationsdatum:
2007
ZDB Id:
1468538-3
ZDB Id:
80069-7
