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Letters to the Editor
more reliable. The three-year OS in BR and R-CHOP treated patients is similar to the population-based cohort reported by Villa et al.8 but lower than after R-CHOP in the European MCL Elderly trial, as may be expected from an unselected cohort.1 In the latter trial, mainte- nance rituximab after R-CHOP was associated with a benefit in OS, which was also demonstrated in younger patients. 1,9 Unfortunately, we were not able to confirm these data in the real-world setting due to a limited num- ber of cases. As our study cannot prove that BR issuperi- or to R-CHOP, durther analysis on the effect of mainte-
nance rituximab would be valuable. HD-AHCT was established in MCL based on its association with improved OS in a randomized European pre-rituximab trial,10 although not confirmed after the addition of ritux- imab and cytarabine to CHOP-based induction and the use of maintenance with rituximab.3,9-11 Consequently, HD-AHCT is currently challenged in the ongoing phase III TRIANGLE (NCT02858258) trial. Reviewing the stan- dardized estimates of OS in our analysis, survival after MCL2 and BR may be comparable during FU initial time, as represented by chemo-sensitive cases. The less steep
Table 1. Patient characteristics. Variable
All patients MCL2 BR R-CHOP Other Curative Other/ systemic* radiotherapy** Missing***
N(col%) N(col%) N(col%) N(col%) N(col%) N(col%) N(col%)
Overall (row %)
Year of diagnosis 2007-2012
2013-2017 Age at diagnosis
Median (IQR) <50
50-59 60-69 70-79 ≥80
Sex Male
Female
Ann Arbor stage
I
II
III
IV
Missing 54(4) 3(1) 9(4) 2(2) 12(5) 2(8) 28(6)
MIPI
Median (IQR) 6.3 (5.9-6.8) 5.9(5.6-6.3) 6.4 (6.1-6.9) 6.5 (6.1-6.9) 6.5 (6.2-7.1) 5.9(5.4-6.2) 6.3 (5.9-6.9)
Low(<5.7) 147(12) 70(26) 7(3) 2(2) 7(2) 6(23) 57(13)
1,277 (100)
667 (52) 610 (48)
71 (64-79)
45(4) 26(10)
268 (21)
151 (56) 117 (44)
231 (18)
81 (35) 150 (65)
75 (71-80)
0(0) 0(0) 1(0) 2(8) 16(4) 2(1) 3(3) 5(2) 6(23) 37(8)
93 (7)
76 (82) 17 (18)
226 (18)
170 (75) 56 (25)
26 (2)
18 (69) 8 (31)
433 (34)
171 (39) 262 (61)
137(11) 376 (29) 411 (32) 308 (24)
912 (71) 365 (29)
85(32) 142 (53) 15 (6) 0 (0)
202 (75) 66 (25)
39 (17) 127 (55) 63 (27)
161 (70) 70 (30)
24 (26) 46 (49) 20 (22)
67 (72) 26 (28)
48 (21) 75 (33) 94 (42)
167 (74) 59 (26)
11 (42) 3 (12) 4 (15)
19 (73) 7 (27)
113 (26) 144 (33) 125 (29)
296 (68) 137 (32)
62 (56-66)
74 (69-79)
76 (70-83)
64 (59-73)
73 (66-81)
70(5) 5(2) 2(1) 3(3) 7(3)
15 (58) 11 (42) (0) (0)
38 (9) 42 (9) 37 (9) 288 (62)
124 (10) 144 (11) 885 (69)
18 (7) 30 (11) 212 (79)
26 (11) 28 (12) 166 (72)
8 (9) 15 (16) 65 (70)
19 (8) 34 (15) 154 (68)
Intermediate(5.7-6.1) High (≥6.1)
Missing
LDH Normal
Elevated
WHO PS
0-1 1,070 (84) 251 (93) 200 (87) 76 (82) 169 (75) 26 (100) 348 (80) 2-4 186 (15) 15 (6) 26 (11) 15 (16) 54 (24) 0 (0) 76 (18) Missing 21(2) 2(1) 5(2) 2(2) 3(1) 0(0) 7(2)
323 (25) 573 (45) 234 (18)
714 (56)
523 (41)
84 (31) 69 (26) 45 (17)
117 (44)
147 (55)
64 (28) 128 (55) 32 (14)
20 (22) 44 (47) 27 (29)
36 (16) 126 (55) 57 (26)
4 (15) 5 (19) 9 (35)
115 (26) 199 (49) 65 (14)
148 (64)
79 (34)
Missing 40(3) 4(1) 4(2) 2(2) 5(2) 1(4) 24(5)
40 (43) 51 (55)
127 (56) 94 (42)
24 (9) 1 (4)
258 60) 151 (35)
WBC
Normal (<9x109/L) Elevated
Missing
580 (45)
503 (39)
194 (15)
131 (49)
99 (37)
38 (11)
103 (45)
103 (45)
25 (11)
35 (38)
33 (35)
25 (27)
91 (40)
79 (37)
51 (24)
13 (50)
4 (15)
9 (35)
207 (48)
185 (42)
46 (10)
* Includes treatment with BAC (bendamustine, cytarabine), chlorambucil, CHOP/cytarabine, cyclophosphamide, cytarabine, CVP (cyclophosphamide, vincristine, pred- nisone), CVIP (cyclophosphamide, etoposide, idarubicin, prednisone), FC (fludarabine, cytarabine), ibrutinib+bendamustine, idarubicin, ixoten, lenalidomide+bendamus- tine.Among these,the most frequently reported regimens were chlorambucil (n= 69) and CHOP/cytarabine (n=59).** Includes patients with AA stage I-II MCL,treated with single radiotherapy with curative intent, radiation dose 30-40 Gy.*** Other/missing includes no treatment given, treatment given but not specified, missing information on treatment and non-curative radiotherapy. MCL: mantle-cell lymphoma; R: Rituximab; CHOP: cyclophosphamide, doxorubicin, vincristine, prednisone; MIPI: MCL International Prognostic Index; N: number; col: column; WBC: white blood cell count; WHO PS: World Health Organization Performance Status. Due to rounding, not all per- centages add up to 100.
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