How to choose between curative radiotherapy or chemotherapy in low stage MCL?—a population‐based analysis of outcome in patients with stage I‐II MCL in Sweden

Abstract

Introduction: The optimal primary treatment of mantle cell lymphoma is not yet defined with respect to long-term disease control and manageable toxicity. A few patients with MCL present with limited stage disease and for these, involved node radiotherapy may be a well tolerable alternative to immunochemotherapy regimens. Here, we aim to evaluate progression free survival (PFS) and overall survival (OS) in relation to given treatment and prognostic factors in patients with stage I-II MCL. Methods: The study was based on patients diagnosed with MCL in Sweden 2006–2018 according to the Swedish Lymphoma Register (SLR), which is a nationwide population-based register with a reported coverage of 95%. Data were supplemented by review of medical records for all patients. Survival analyses were made by Kaplan-Meier estimates with end of given treatment as start of follow-up (FU). Results: Out of all patients (n = 1412), we identified a cohort of 173 patients reported with Ann Arbor I-II or Musshoff PeI according to standard staging procedure. Median age was 71(22–93) years, 88% had ECOG 0–1 and 31% were scored high-risk MIPI at diagnosis. Primary treatment included single RT (n = 48, 28%) of which curative radiation dose ≥24 Gy in 37 (21%) patients, Immunochemotherapy (ICT) (n = 94, 54%) including R-bendamustine (n = 34), Nordic MCL2 protocol (n = 28), R-CHOP (n = 14), and ICT with consolidative RT in 12 (7%) (CRT). At a median FU time of 5.40 (0.01–15.46) years (y), median OS in the cohort was 9.56 y (95% CI: 6.60-NR). 5-y-OS (95% CI) after ICT was 0.64(0.53–0.73), after single RT ≥24 Gy 0.84(0.67–0.92) and 0.58(0.27–0.80) after CRT (Figure 1a). Median progression-free survival (PFS) in the cohort was 3.55 y (95% CI: 2.53–6.08). 5-y-PFS (95% CI) was 0.47 (0.36–0.58) after ICT, 0.40 (0.24–0.55) after single RT ≥24 Gy and 0.55 (0.23–0.78) after CRT (Figure 1b). The research was funded by: Mrs Berta Kamprad´s foundation. The research was made possible in part by research funding from Janssen Pharmaceuticals AB Keywords: Aggressive B-cell non-Hodgkin lymphoma, Chemotherapy, Radiation Therapy No conflicts of interests pertinent to the abstract.