Blood Journal
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Early consolidation by myeloablative radiochemotherapy followed by autologous stem cell transplantation in first remission significantly prolongs progression-free survival in mantle-cell lymphoma: results of a prospective randomized trial of the European MCL Network

  1. Martin Dreyling,
  2. Georg Lenz,
  3. Eva Hoster,
  4. Achiel Van Hoof,
  5. Christian Gisselbrecht,
  6. Rudolf Schmits,
  7. Bernd Metzner,
  8. Lorenz Truemper,
  9. Marcel Reiser,
  10. Hjalmar Steinhauer,
  11. Jean-Michel Boiron,
  12. Marc A. Boogaerts,
  13. Ali Aldaoud,
  14. Vittorio Silingardi,
  15. Hanneke C. Kluin-Nelemans,
  16. Joerg Hasford,
  17. Reza Parwaresch,
  18. Michael Unterhalt, and
  19. Wolfgang Hiddemann
  1. From the Department of Internal Medicine III, Ludwig-Maximilians University, Munich, Germany; Department of Medical Informatics, Biometrics and Epidemiology (IBE), Ludwig-Maximilians University, Munich, Germany; Department of Hematology, Hopital St-Jan, Brugge, Belgium; Department of Hematology, Hopital Saint Louis, Paris, France; Department of Hematology and Oncology, University of Saarland, Homburg/Saar, Germany; Department of Internal Medicine II, Klinikum Oldenburg, Germany; Department of Hematology and Oncology, Georg August University, Goettingen, Germany; Department of Internal Medicine I, University of Cologne, Germany; Department of Internal Medicine II, Carl-Thiem Klinikum, Cottbus, Germany; Haut-Leveque Hospital, University of Bordeaux, France; Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium; Praxis für Hämatologie/Onkologie, Leipzig, Germany; Department of Medical Oncology, University of Modena, Italy; Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands; and Department of Hematopathology, University of Kiel, Germany.

Abstract

Mantle-cell lymphoma (MCL) is characterized by poor prognosis with a median survival of only 3 to 4 years. To improve clinical outcome, the European MCL Network initiated a randomized trial comparing consolidation with myeloablative radiochemotherapy followed by autologous stem cell transplantation (ASCT) to α-interferon maintenance (IFNα) in first remission. Patients 65 years of age or younger with advanced-stage MCL were assigned to ASCT or IFNα after achievement of complete or partial remission by a cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)–like induction therapy. According to the International Prognostic Index (IPI), 43% of patients had a low-risk, 41% a low-intermediate, 11% a high-intermediate, and 6% a high-risk profile. Sixty-two of 122 patients proceeded to ASCT and 60 received IFNα. Patients in the ASCT arm experienced a significantly longer progression-free survival (PFS) with a median of 39 months compared with 17 months for patients in the IFNα arm (P = .0108). The 3-year overall survival (OS) was 83% after ASCT versus 77% in the IFN group (P = .18). Early consolidation by myeloablative radiochemotherapy followed by ASCT is feasible and results in a significant prolongation of PFS in advanced-stage MCL. Longer follow-up is needed to determine the effect on OS.

  • Submitted October 6, 2004.
  • Accepted November 28, 2004.
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