15-year follow-up of the Second Nordic Mantle Cell Lymphoma trial (MCL2): prolonged remissions without survival plateau
15-year follow-up of the Second Nordic Mantle Cell Lymphoma trial (MCL2): prolonged remissions without survival plateau
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DOI：
10.1111/bjh.14241
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发表时间：
2016-11-01
影响因子：
6.5
通讯作者：
Geisler, Christian H.
中科院分区：
文献类型：
--
作者：
Eskelund, Christian W.;Kolstad, Arne;Geisler, Christian H.
近几十年来，套细胞淋巴瘤（MCL）的预后已得到显着改善的强化一线方案，包括阿糖胞苷，利妥昔单抗和巩固与大剂量治疗和自体干细胞移植。其中一种策略是北欧MCL 2方案，由北欧淋巴瘤组开发。我们在此介绍了Nordic MCL 2研究的15年最新结果，中位随访时间为114年：所有患者在意向治疗的基础上，中位总生存期和无进展生存期分别为127年和85年。特别是MCL国际预后指数（MIPI）、生物学MIPI（包括Ki 67表达）（MIPI-B）和MIPI-B（包括mIR-18 b表达）（MIPI-B-miR）将患者显著分为不同的风险组。尽管低危组和中危组的反应持续时间很长，但我们观察到复发的连续模式，生存曲线从未达到平台。总之，尽管有一半的患者仍然存活，40%的患者在超过12年后首次缓解，但我们仍然看到过高的疾病相关死亡率，即使在经历长期缓解的患者中也是如此。尽管我们认为Nordic方案是一个非常好的方案选择，但我们建议纳入前瞻性研究，以探索新型药物在MCL一线治疗中的获益。
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 114years: For all patients on an intent-to-treat basis, the median overall and progression-free survival was 127 and 85years, 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 12years, 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.