Jerkeman Mats, Ekberg Sara, Glimelius Ingrid, Albertsson-Lindblad Alexandra, Entrop Joshua P, Ellin Fredrik, Sonnevi Kristina, Lewerin Catharina, Brandefors Lena, Smedby Karin E
Department of Clinical Sciences Lund, Division of Oncology, Skåne University Hospital, Lund University, Lund, Sweden.
Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.
Hemasphere. 2023 Jul 28;7(8):e928. doi: 10.1097/HS9.0000000000000928. eCollection 2023 Aug.
Mantle cell lymphoma (MCL) is a B-cell malignancy currently considered incurable. Although some patients obtain prolonged remission after first-line chemoimmunotherapy, many will need several treatment lines. Here, we present a nationwide assessment of treatment strategies, time to progression and survival in MCL. All patients diagnosed with MCL 2006-2018 were identified in the Swedish Lymphoma Register. Information on all lines of therapy was extracted from the medical records. Overall and progression-free survival (OS and PFS) were assessed through August 2021. In total, 1367 patients were included (median age, 71 years) and median follow-up was 6.8 years. Two hundred and one (15%) were managed initially with watch-and-wait, but 1235 (90%) eventually received treatment. The most frequently used first-line regimens were rituximab-bendamustine (BR) (n = 368; 30%) and Nordic MCL2 (n = 342; 28%). During follow-up, 630 patients (46%) experienced relapse/progression and 546 (40%) received second-line treatment. The most frequently used second-line regimen was BR (n = 185; 34%) but otherwise a wide variety of second-line treatments were used. Further, 382 and 228 patients experienced a second or third relapse/progression, respectively. Median PFS after first (PFS-1), second (PFS-2), third (PFS-3), and fourth (PFS-4) treatment lines was 29.4, 8.9, 4.3, and 2.7 months. Patients with early progression, defined as a PFS-1 <24 months, had an inferior median OS of 13 versus 37 months in patients with later relapse. For patients treated with frontline BR, however, time to relapse had no impact on later outcome. By use of nationwide population-based data, we provide important benchmarks for future studies of all treatment lines in MCL.
套细胞淋巴瘤（MCL）是一种目前被认为无法治愈的B细胞恶性肿瘤。尽管一些患者在一线化疗免疫治疗后获得了长期缓解，但许多患者仍需要多线治疗。在此，我们对MCL的治疗策略、疾病进展时间和生存率进行了全国性评估。在瑞典淋巴瘤登记处确定了所有在2006年至2018年期间被诊断为MCL的患者。从医疗记录中提取了所有治疗线的信息。通过2021年8月评估总生存期和无进展生存期（OS和PFS）。总共纳入了1367例患者（中位年龄71岁），中位随访时间为6.8年。201例（15%）最初采用观察等待策略，但1235例（90%）最终接受了治疗。最常用的一线方案是利妥昔单抗-苯达莫司汀（BR）（n = 368；30%）和北欧MCL2方案（n = 342；28%）。在随访期间，630例患者（46%）出现复发/进展，546例（40%）接受了二线治疗。最常用的二线方案是BR（n = 185；34%），但其他方面使用了多种二线治疗方法。此外，分别有382例和228例患者经历了第二次或第三次复发/进展。一线（PFS-1）、二线（PFS-2）、三线（PFS-3）和四线（PFS-4）治疗后的中位PFS分别为29.4个月、8.9个月、4.3个月和2.7个月。疾病早期进展的患者，定义为PFS-1<24个月，其OS中位数为13个月，而复发较晚的患者为37个月。然而，对于接受一线BR治疗的患者，复发时间对后续结局没有影响。通过使用基于全国人群的数据，我们为未来MCL所有治疗线的研究提供了重要的基准。
