There is no generally established prognostic index for patients with mantle cell lymphoma (MCL),

From 2002 to 2007, 103 patients with primary myelofibrosis or postessential thrombocythemia and polycythemia vera myelofibrosis and a median age of 55 years (range, 32-68 years) were included in a prospective multicenter phase 2 trial to determine efficacy of a busulfan (10 mg/kg)/fludarabine (180 mg/m 2 )-based reduced-intensity conditioning regimen followed by allogeneic stem cell transplantation from related (n ‫؍‬ 33) or unrelated donors (n ‫؍‬ 70). All but 2 patients (2%) showed leukocyte and platelet engraftment after a median of 18 and 22 days, respectively. Acute graft-versushost disease grade 2 to 4 occurred in 27% and chronic graft-versus-host disease in 43% of the patients. Cumulative incidence of nonrelapse mortality at 1 year was 16% (95% confidence interval, 9%-23%) and significantly lower for patients with a completely matched donor (12% vs 38%; P ‫؍‬ .003). The cumulative incidence of relapse at 3 years was 22% (95% confidence interval, 13%-31%) and was influenced by Lille risk profile (low, 14%; intermediate, 22%; and high, 34%; P ‫؍‬ .02). The estimated 5-year event-free and overall survival was 51% and 67%, respectively. In a multivariate analysis, age older than 55 years (hazard ratio ‫؍‬ 2.70; P ‫؍‬ .02) and human leukocyte antigenmismatched donor (hazard ratio ‫؍‬ 3.04; P ‫؍‬ .006) remained significant factors for survival. The study was registered at www. clinicaltrials.gov as #NCT 00599547. (Blood. 2009;114:5264-5270)

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The combined immunochemotherapy with R-CHOP resulted in a significantly higher response rate and a prolongation of the TTF as compared with chemotherapy alone. Hence, R-CHOP may serve as a new baseline regimen for advanced stage MCL, but needs to be further improved by novel strategies in remission.