Stem cell transplantation for mantle cell lymphoma: should it ever be used outside clinical trials?

Abstract

Summary:The outlook for patients with mantle cell lymphoma is poor. The reported median survival in most published series is only 3 to 4 years, and even the most favorable prognostic groups have median survival rates of only 5 years, with no evidence of cure. The use of autologous and allogeneic stem cell transplantation in this disease has increased dramatically in recent years. Despite encouraging reports from single centers and registries, the impact of stem cell transplantation on the outcome for mantle cell lymphoma is unclear. Optimal first-line regimens for mantle cell lymphoma have yet to be defined, and it is therefore difficult to place the role of first remission transplantation in an appropriate context. Prospective randomized trials have been difficult to design and conduct in the absence of a well-defined 'standard' treatment. The role of stem cell transplantation as a salvage strategy is also unknown, although available data suggest that it does not improve survival in heavily pre-treated patients. In the absence of clear evidence for a survival advantage for patients receiving stem cell transplants for mantle cell lymphoma, entry into clinical trials should be a priority. Bone Marrow Transplantation (2001) 28, 813-820.

Long-term remission in mantle cell lymphoma following high-dose sequential chemotherapy and in vivo rituximab-purged stem cell autografting (R-HDS regimen)

“…These include the use of new drugs, aggressive leukemia-like regimens, 10 and high-dose myeloablative chemotherapy or chemo-radioimmunotherapy 26 followed by either autologous or allogeneic stem cell transplantation, as reviewed by Sweetenham. 27 The main goals of our study were as follows: (1) to confirm the original observation 15 that the combination of highdose chemotherapy and rituximab is an efficient in vivo purging strategy in MCL; and (2) to assess in a multicenter setting the feasibility, toxicity, and long-term efficacy of a high-dose sequential treatment that included a tandem transplantation, as well as the use of rituximab (R-HDS), as induction treatment in a larger series of consecutive patients with newly diagnosed, advanced-stage MCL.…”

Indução de quimerismo hematopoetico misto com fludarabina e irradiação corporal total pre transplante de celulas progenitoras perifericas, em pacientes com neoplasias hematologicas

“…ii.) Para os Linfomas não-Hodgkin (LNH), há forte evidência da sensibilidade ao efeito ECM nos linfomas foliculares (Marks et al,2002), e parece haver forte evidência do efeito ECM nos linfomas das células do manto (Khouri et al, 2001;Sweetenham et al, 2001;Khouri et al, 2003; Na Leucemia Linfocítica Crônica (LLC), resposta duradoura após ILD sugere sensibilidade desta doença ao efeito ECM, porém o efeito ECM praticamente inexiste em pacientes com crescimento tumoral rápido (Dreger et al, 2002). Não há dados conclusivos sobre sensibilidade ao efeito ECM nos linfomas B de grandes células (Grigg & Ritchie, 2004), e muito provavelmente os linfomas linfoblástico e Burkitt não sejam sensíveis ao efeito ECM.…”