Primary treatment with autologous stem cell transplantation in mantle cell lymphoma: outcome related to remission pretransplant

Andersen, Niels Smedegaard; Pedersen, Lone Bredo; Elonen, Erkki; Johnson, Anna; Kolstad, Arne; Franssila, Kaarle; Langholm, Ruth; Ralfkiær, Elisabeth; Åkerman, Måns; Eriksson, Mikael; Kuittinen, Outi; Geisler, Christian H.

doi:10.1034/j.1600-0609.2003.00093.x

Cited by 73 publications

(75 citation statements)

References 24 publications

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“…Chemotherapy using cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) does not seem to result in a relevant reduction of tumor load in PB, BM, or PB stem cell products, even among patients who achieve a clinical remission, as reported in the Nordic MCL1 study 5 and a single-center series of homogeneously treated patients (Table 2). 16 Immunochemotherapy with rituximab plus CHOP (R-CHOP) in the MCL Younger and MCL Elderly trials showed (for the first time) relevant rates of molecular remission (MRD negativity) of 40%, with 21% of patients MRD negative already at midterm induction.…”

Section: Mrd During and After Induction Treatmentmentioning

confidence: 96%

“…Four studies consistently reported that the presence of or the relative content of tumor cells in the stem cell product did not affect further clinical outcome. 5,16,29,31 This could indicate that tumor cells contaminating the reinfused stem cells might not be able to cause or promote clinical progression, and that cytoreduction in the involved tissues by induction and consolidation treatment has the strongest impact on tumor control.…”

Section: Prognostic Value Of Mrd Before High-dose Consolidationmentioning

confidence: 99%

“…MCL is considered incurable; relapses are common, and MCL has a shorter overall survival (OS) compared with other lymphoma entities. In the past 20 years, the introduction of immunochemotherapy, 1,2 high-dose cytarabine (HA), 3,4 high-dose consolidation followed by autologous stem cell transplantation (ASCT), 5,6 bendamustine, 7 and rituximab maintenance 8 have substantially improved the outcome of patients with MCL. Currently, new targeted drugs that aim at long-term control or even cure of MCL are under investigation.…”

Section: Introductionmentioning

confidence: 99%

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Minimal residual disease in mantle cell lymphoma: insights into biology and impact on treatment

Hoster

Pott

2016

Hematology

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Despite the recent substantial improvement of clinical outcome in mantle cell lymphoma (MCL), resistance to immunochemotherapy and common relapses are challenges for long-term tumor control. The assessment of minimal residual disease (MRD) by real-time quantitative polymerase chain reaction has emerged as a widely feasible and standardized tool for direct assessment of therapy-induced reduction of tumor burden and regrowth after cytotoxic treatment in MCL, with much improved sensitivity compared with conventional staging procedures. Several studies have shown that intensification of initial treatment, which has resulted in improved clinical outcome, is immediately reflected in higher molecular remission rates; they have also shown that high-dose consolidation might not be able to compensate for less intensive induction regimens. Persistence or reappearance of MRD in clinical remission proved to be highly predictive for imminent clinical relapse associated with shorter overall survival. Therefore, the investigation of novel MRD-guided treatment strategies aimed at early eradication of MRD and pre-emptive treatment of molecular relapse seems warranted. Furthermore, the integration of MRD assessment into clinical response criteria could result in a more specific and potentially earlier end point for treatment efficacy. New technical developments such as high-throughput sequencing will further enhance the wide applicability of MRD detection in MCL.Learning Objectives

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Section: Mrd During and After Induction Treatmentmentioning

confidence: 96%

Section: Prognostic Value Of Mrd Before High-dose Consolidationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Minimal residual disease in mantle cell lymphoma: insights into biology and impact on treatment

Hoster

Pott

2016

Hematology

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“…6,[9][10][11] The superior outcome of patients transplanted in CR1 has been a consistent finding in most reported series, and argues for the application of high-dose therapy with autologous HPCT as part of the primary treatment. 5,[12][13][14][15][16] Nevertheless, it remains unclear whether autologous HPCT is actually curative, and the optimal timing of transplantation remains a point of debate.…”

Section: Introductionmentioning

confidence: 83%

“…9,12 In our patient population, 16 patients (76%) were in CR1 at the time of transplant and five patients (24%) were in PR1. There was one biopsy-proven late relapse 9 years post transplant; the remaining three relapses occurred 1.8, 2 and 2.9 years after transplant.…”

Section: Discussionmentioning

confidence: 99%

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

Murali

Winton

Waller

et al. 2008

Bone Marrow Transplant

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Autologous hematopoietic progenitor SCT (HPCT) has been studied both as a consolidative and salvage maneuver in mantle-cell lymphoma (MCL), and may improve failurefree survival rates as well as overall survival. We describe 21 patients with MCL who received autologous HPCT at Emory University Hospital as part of the primary treatment strategy. Sixteen patients were in CR1 and five in PR1 at the time of HPCT. The most commonly used induction chemotherapy was the hyper-CVAD (cyclophosphamide, vincristine, doxorubicin and dexamethasone) regimen with or without rituximab. At the last follow-up, 17 patients were in continuous CR, and there were four relapses. There were no transplant-related deaths. With a median follow-up of 54 months from HPCT, 5-year progression-free survival and overall survival are 73% and 76%, respectively. Our retrospective analysis provides the longest follow-up to date for patients with MCL who received an autologous HPCT as part of primary treatment. This lengthy follow-up helps define the natural course of MCL after autologous transplantation.

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Outcomes of both abbreviated hyper‐CVAD induction followed by autologous hematopoietic cell transplantation and conventional chemotherapy for mantle cell lymphoma: a 10‐year single‐centre experience with literature review

et al. 2015

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We retrospectively evaluated consecutive patients diagnosed with Mantle cell lymphoma (MCL) between 01 January 2000 and 31 December 2009. Eighty eight patients with MCL were included in the analysis of whom 46 (52%) received abbreviated Hyper‐CVAD (a total of two cycles; with addition of Rituximab since 2005) with an intention of proceeding to autologous hematopoietic cell transplantation (auto‐HCT), with a median age of 58 years. Response rate to induction at auto‐HCT time was 89% and complete response was 61%. Forty four patients received an auto‐HCT with a 5‐year progression‐free survival (PFS) and overall survival (OS) were 31.2% and 62.5%, respectively. There were 42 nontransplant eligible patients with a median age of 72 years, and 5‐year PFS and OS were 0.0% and 39.9%, respectively. The median survival and PFS in the auto‐HCT eligible group were 68 and 33 months, compared to 32 and 12 months in nontransplant eligible group, without a plateauing of the survival curves in either group. Treatment‐related mortality in the auto‐HCT eligible group was 10.9% (n = 5); two patients died during R‐Hyper‐CVAD and 3 (6.8%) experienced transplant‐related mortality. An abbreviated R‐Hyper‐CVAD‐based induction strategy followed by consolidative auto‐HCT is feasible and provides moderate potential of long‐term survival. Further research to define risk‐adapted strategies; to optimize disease control, is required.

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Primary treatment with autologous stem cell transplantation in mantle cell lymphoma: outcome related to remission pretransplant

Abstract: In MCL, an important strategy to improve the outcome will be to intensify the induction chemotherapy.

Cited by 73 publications

References 24 publications

Minimal residual disease in mantle cell lymphoma: insights into biology and impact on treatment

Minimal residual disease in mantle cell lymphoma: insights into biology and impact on treatment

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

Outcomes of both abbreviated hyper‐CVAD induction followed by autologous hematopoietic cell transplantation and conventional chemotherapy for mantle cell lymphoma: a 10‐year single‐centre experience with literature review

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