Long-term progression-free survival after early autologous transplantation for mantle-cell lymphoma

Murali, S; Winton, EF; Waller, Edmund K.; Heffner, Leonard T.; Lonial, Sagar; Flowers, Christopher R.; Kaufman, Jonathan L.; Arellano, Martha; Lechowicz, Mary Jo; Mann, Karen P.; Khoury, H. Jean; Langston, Amelia

doi:10.1038/bmt.2008.201

Cited by 17 publications

(10 citation statements)

References 32 publications

(32 reference statements)

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“…The addition of rituximab to the front-line chemotherapy i.e. CHOP (Rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisone), DHAP and mainly Hyper CVAD (cyclophosphamide, vincristine, doxorubicin, decadron, high dose cytarabine and methotrexate) and its incorporation into stem cell mobilisation and conditioning regimens can lead to long-term progression-free survival of MCL with perhaps a cured fraction [41,43,44].…”

Section: Treatmentmentioning

confidence: 99%

“…If the patient is under 65 yr old in a good physical condition intensive front-line immunochemotherapy with autologous stem cell transplantation (SCT) has to be considered as an option [41,42]. In 21 patients with MCL who received autologous haematopoietic progenitor SCT (HPCT) at Emory University Hospital as part of the primary treatment strategy with a median follow-up of 54 months from HPCT, 5-year progression-free survival and overall survival were 73% and 76%, respectively [41]. The addition of rituximab to the front-line chemotherapy i.e.…”

Section: Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Primary gastrointestinal tract mantle cell lymphoma as multiple lymphomatous polyposis

Ruskoné-Fourmestraux

Audouin²

2010

Best Practice & Research Clinical Gastroenterology

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Primary gastrointestinal tract mantle cell lymphoma as multiple lymphomatous polyposis

Ruskoné-Fourmestraux

Audouin²

2010

Best Practice & Research Clinical Gastroenterology

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“…13,14 There is no standard therapy for newly diagnosed MCL, although approaches combining high-dose cytarabine with autologous stem cell transplantation result in high response rates and increasing durations of response. 15,16 The outcomes for R-CHOP alternating with R-DHAP (dexamethasone, high-dose cytarabine, cisplatin) followed by stem cell transplantation are particularly encouraging, with a median event-free survival of 83 months. 15 In the nontransplantation setting, R-bendamustine has a median PFS of nearly 3 years and R-HyperCVAD without transplantation results in a median time to treatment failure of 4.6 years for patients with MCL.…”

Section: Baseline Risks Of Relapse For Various Nhl Subtypesmentioning

confidence: 99%

Optimal disease surveillance strategies in non-Hodgkin lymphoma

Cohen

Flowers

2014

Hematology

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Given the paucity of randomized controlled trial data, defining the ideal strategy for surveillance imaging in patients with non-Hodgkin lymphoma (NHL) has become increasingly challenging. The routine use of frequent surveillance scans has been a common component of patient care. Emerging data from prospective and retrospective observational studies and modeling approaches have highlighted the performance characteristics of imaging modalities and the challenges with this form of secondary screening. The majority of patients with relapsed lymphoma have clinical signs or symptoms that prompt further evaluation, and only a small proportion of patients experience relapse detected on a routine scan while being otherwise asymptomatic. Surveillance imaging is costly, may expose patients to minimal risks of mortality due to radiation-related secondary malignancies, and can lead to false-positive findings, leading to unnecessary biopsies. In addition, no prospective study has demonstrated a significant improvement in overall survival for those patients whose disease is discovered on a routine scan versus those who present with clinical symptoms. In this chapter, we examine the baseline risks of relapse for various NHL subtypes that provide the context for surveillance, review the data on imaging modalities, and establish a framework for discussing optimal surveillance strategies with individual patients. Patients should be counseled on the risks and benefits of routine surveillance imaging and decisions regarding surveillance should be made on an individual basis using patient-specific risk factors, response to induction therapy, and patient preferences with a bias toward using surveillance imaging in the 2 years after treatment only in those NHL patients with the greatest likelihood of benefit. Learning Objectives• To review recent literature regarding the use of routine imaging surveillance for patients with NHL achieving a CR to induction therapy • To develop an approach for counseling patients regarding the risks and benefits of surveillance imaging Baseline risks of relapse for various NHL subtypesThe completion of induction therapy and achievement of a complete response (CR) is a significant milestone for patients with lymphoma, but the optimal follow-up for these patients remains a subject of intense debate, especially with regard to the appropriate use of routine surveillance imaging. Unfortunately, a significant portion of patients with non-Hodgkin lymphoma (NHL) who achieve a CR will relapse and require additional treatment. In diffuse large B-cell lymphoma (DLBCL), for example, the CR rate for current standard therapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) is 75%-86%, but up to 1/3 of these patients will ultimately relapse. 1,2 The International Prognostic Index (IPI) can assist with risk stratification for newly diagnosed patients. Patients with a high-risk IPI who achieve a CR have an estimated 5-year relapse-free survival of 40% compared with 70% for patients wit...

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“…In general, the absence of demonstration of cyclin D1 overexpression or the molecular hallmark of MCL should raise doubt as to the diagnosis, although rare atypical cyclin D1 negative and/or t(11;14) negative cases otherwise indistinguishable from classic MCL have been described. Demonstration of Sox11 overexpression may be useful in these cases [Ek et al 2008]. The incidence of MCL is widely referenced as being 2-10% of non-Hodgkin lymphomas.…”

Section: Pathologymentioning

confidence: 99%

Initial therapy of mantle cell lymphoma

Inwards¹,

Witzig²

2011

Therapeutic Advances in Hematology

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Mantle cell lymphoma is a well-recognized distinct clinicopathologic subtype of B-cell non-Hodgkin lymphoma. The current World Health Organization (WHO) classification subdivides this entity into aggressive and other variants. The disease has a predilection for older males, and patients typically present at an advanced stage with frequent splenomegaly and extranodal involvement including bone marrow, peripheral blood, gastrointestinal, and occasional central nervous system involvement. Early studies of therapy outcomes in this disease revealed that while response rates where high, relapse was expected after a limited period of time. Prolonged survival was uncommon, with initial median survival rates typically in the 3-4-year range. Those with a high proliferative rate, blastoid morphology, and selected clinical features were recognized as having a worse prognosis. Therapeutic approaches have diverged into aggressive therapies with high response rates and promising progression free survival rates, which may be applied to younger healthy patients, and less aggressive approaches. Aggressive therapies include intensive chemotherapy alone or chemotherapy followed by autologous stem cell transplant, which has been shown to be most effective when applied in first remission. Whether these more intense therapies result in improved survival as compared with less aggressive therapies is not well established. Allogeneic transplant has also been investigated, although high treatment-related mortality and the risk of chronic graft versus host disease and the relatively advanced age of this patient population have tempered enthusiasm for this approach. A number of less aggressive therapies have been shown to produce promising results. Consolidation and maintenance strategies are an active area of investigation. A number of newer agents have shown promising activity in relapsed disease, and are being investigated in the front-line setting. Overall survival rates are improving in this disease, with current studies suggesting a median survival of 5 or more years.

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Long-term progression-free survival after early autologous transplantation for mantle-cell lymphoma

Cited by 17 publications

References 32 publications

Primary gastrointestinal tract mantle cell lymphoma as multiple lymphomatous polyposis

Primary gastrointestinal tract mantle cell lymphoma as multiple lymphomatous polyposis

Optimal disease surveillance strategies in non-Hodgkin lymphoma

Initial therapy of mantle cell lymphoma

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