Autologous stem cell transplantation in mantle cell lymphoma: a report from the SFGM-TC

Abstract

Autologous stem cell transplantation (ASCT) is considered as an attractive treatment option for young mantle cell lymphoma (MCL) patients. This retrospective SFGM-TC study analyzed the outcome of 500 MCL patients treated with ASCT and investigated parameters that may modify the outcome of patients who proceeded to ASCT upfront (n = 396). For all patients, median age at ASCT was 56 years (range, 26-71). Median follow-up was 34 months. Three-year progression free survival (PFS) and overall survival (OS) were 63.5 % [95 % CI, 58.7-68.6 %] and 79.5 % [95 % CI, 75.3-83.4 %], respectively. Median time from ASCT to relapse was 22 months (range, 0-136 m). For patients transplanted upfront and in multivariate analysis, age (HR = 2 [1.2-3.4], p = .01, and HR = 2.3 [1.2-4.5], p = .01), disease status at time of ASCT (HR = 1.7 [1.1-2.6], p = .01 and HR = 1.8 [1.1-3.1], p = .03), and use of rituximab (HR = 0.5 [0.3-0.8], p = .002 and HR = 0.5 [0.3-0.9], p = .01) were statistically predictive for both PFS and OS. Also, first line treatment including anthracycline and high-dose cytarabine followed by ASCT conditioned with TAM improved PFS. To conclude, this study suggests that ASCT in MCL can provide a high response rate but may not be sufficient to cure MCL even when ASCT is performed upfront, highlighting the need for innovative approaches before ASCT, aiming to increase complete response rate, and after ASCT, to maintain response.

Bendamustine-based conditioning for non-Hodgkin lymphoma autologous transplantation: an increasing risk of renal toxicity

“…[3][4][5] Otherwise, ASCT can also be considered as an attractive treatment option for mantle-cell lymphoma (MCL) patients under 60 years. 6,7 Since the 1980's, various conditioning regimens have been used and none of them has demonstrated superiority to another. To date, BEAM (carmustine 300 mg/m 2 IV on day − 6, etoposide 100 mg/m 2 IV bid on day − 5 to − 2, cytarabine 100 mg/m 2 IV bid on day − 5 to − 2, melphalan 140 mg/m 2 on day − 1)-conditioning regimen is one of the standards of care for first line or relapsed NHL patients receiving consolidation with ASCT.…”

Specific Features Identify Patients with Relapsed or Refractory Mantle Cell Lymphoma Benefitting from Autologous Hematopoietic Cell Transplantation

“…There were not sufficient data to include Ki-67 or positron emission tomography results in our models, though they have been shown by others to be significant [4,12,15–17]. It is noteworthy that remission status and blastoid histology were not significant in our multivariable model, while their association with outcomes in MCL are frequently cited [4,11,17]. Perhaps the sMIPI-Auto, B symptoms, and RQ capture similar biologic or clinical features that these other factors describe.…”

Phase II Trial of Tandem High-Dose Chemotherapy with Autologous Stem Cell Transplantation Followed by Reduced-Intensity Allogeneic Stem Cell Transplantation for Patients with High-Risk Lymphoma

“…Many well defined risk factors are predictive of relapse after AutoSCT including histology (e.g. mantle cell lymphoma (1,2) or peripheral T-cell lymphoma(3)), primary refractory disease (4), and early relapse. (5) Allogeneic hematopoietic SCT (AlloSCT) is considered in a subgroup of patients with a chemosensitive relapse after autoSCT with the goal of achieving a durable remission through an immunologically driven graft-versus-lymphoma (GVL) effect.…”