EHA 2020 – “Nordic” treatment of mantle cell lymphoma superior to CHOP, Swedish data show


  • Michael Simm
  • Univadis
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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.