Investigators claim a two-fold increase in overall survival in advanced stage MCL.

German investigators, including Martin Dreyling, MD of LRF’s Scientific Advisory Board and Mantle Cell Lymphoma (MCL) Consortium published findings in the Journal of Clinical Oncology that the median overall survival for advanced stage MCL has gone from 2.7 to 4.8 years in the past three decades. Using sophisticated statistics and comparing data from two large clinical trials—the Kiel Lymphoma Study Group (KLSG, 1975-1986) and the German Low Grade Lymphoma Study Group (GLSG, 1996-2004)—the manuscript outlined the changes and improvements made in the diagnosis, treatment, and understanding of MCL.

Investigators postulate several reasons for great improvment in outcomes; from clinical parameters (improved diagnostics, staging techniques, patient selection, and cytostatic therapies) to general improvements in healthcare in the last 30 years—for example, the average survival expectancy in the general population has increased 2.7 years and 3.0 years for men and women respectively.  A shift from the use of chlorambucil to anthracycline-containing combinations and the addition of the anti-CD20 antibody rituximab to CHOP therapy is thought to be a great factor in the improved overall survial in advanced stage MCL.  Physicians also now think of MCL as an aggressive disease needing earlier and more vigorous treatment whereas 30 years ago it was classified as an indolent disease, treated only with observation until symptomatic.

Study Details

The earlier KLSG study had 150 patients divided into two arms: observation until presentation of clinical symptoms (subsequently treated with 12 cycles of chlorambucil/prednisone, additional radiation therapy and maintenance) and a COP (cyclophosphamide, vincristine, prednisone) versus CHOP (cyclophosphamide, vincristine, prednisone, doxorubicin) therapy arm. Taking place in the 1970s and 80s, the Kiel classification system was used and included “centrocytic lymphoma” in the definition of MCL; in order to make the datasets comparable, cases of blastoid MCL were removed from the GLSG data, which used WHO classification.

The more recent GLSG study enrolled 370 patients and had the advantage of immunohistochemistry to improve diagnosis.  Patients were randomized into a MCP (mitoxantrone, chlorambucil, prednisone) versus CHOP arm or a CHOP versus R-CHOP (CHOP plus rituximab) arm.  To create a more uniform study population, a number of patients with serious accompanying disease were excluded, in effect improving the population’s prognosis. 

Dr. Dreyling and colleagues put in place a frequency matching procedure to more appropriately compare the KLSG and GLSG patients. Survival data is summarized as follows:

The study acknowledges the potential bias of historical comparisons but the data remains compelling.  Median overall survival of patients with advanced stage MCL has nearly doubled in the past 30 years and cotinued advancements in technology, treatment and overall healthcare should improve prognosis even more.

* Overall Survival not yet reached in R-CHOP group. The two-year survival rate is 81% with a median follow-up of = 1.5 years.

The study acknowledges the potential bias of historical comparisons but the data remains compelling.  Median overall survival of patients with advanced stage MCL has nearly doubled in the past 30 years and cotinued advancements in technology, treatment and overall healthcare should improve prognosis even more.