- A protocol of R-CHOP and R-HD-cytarabine that has been adapted for fit patients with mantle cell lymphoma (MCL) in Sweden is noninferior to bendamustine.
- A significant proportion of patients did not receive treatment and had a median overall survival of 4.1 years.
Why this matters
- The optimal treatment of MCL is not defined.
- Guidelines recommend R-CHOP and R-bendamustine (RB) for elderly, frail patients. For young and fit patients, intensified chemotherapy with autologous stem cell support is advised. The protocol practiced in Sweden is the “nordic MCL2” with R-CHOP and R-HD-cytarabine.
- There were no population-based studies on survival in the post-rituximab era.
- Analysis based on Swedish Lymphoma Registry and National Population Registry for MCL from 2007-2017. Minimum follow-up was 1 year; 1277 patients with a median age of 71 years.
- Funding: Swedish Cancer Society and Janssen Pharmaceuticals.
- Median overall survival was 4.8 years for all patients with a median follow-up of 5.9 years.
- Patients receiving nordic MCL were significantly younger, had a better performance status, and less often at high risk.
- After adjusting for age, sex, and calendar year of diagnosis, the HR in comparison to bendamustine showed inferiority of CHOP (HR, 1.42; P=.028) and no significant difference with nordic MCL (HR, 0.90; not significant).
- Patients who received no treatment at diagnosis (n=144) had a median age of 75 years and median OS of 4.1 years.