Nonablative Allogeneic Stem-Cell Transplantation for Advanced/Recurrent Mantle-Cell Lymphoma

Khouri, Issa F.; Lee, Ming S.; Saliba, Rima M.; Gu, Jun; Fayad, Luis; Younes, Anas; Pro, Barbara; Acholonu, Sandra; McLaughlin, Peter; Katz, Ruth L.; Champlin, Richard E.

doi:10.1200/jco.2003.05.501

Cited by 195 publications

(106 citation statements)

References 16 publications

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“…In addition, the fact that a proportion of relapsed and refractory DLBCL patients (even those with chemoresistant disease) 6 can achieve long-term remission after non-myeloablative (NMAC) and reduced-intensity (RIC)-conditioning allo-HCT suggests that a clinically meaningful GVL effect exists and benefits some patients with DLBCL. 1,[43][44][45][46][47] Thus, there is evidence to support a GVL effect in DLBCL. Differences in the intrinsic antigen-presenting ability of DLBCL cells as compared with indolent lymphomas may provide an explanation for a potentially weaker GVL effect in DLBCL.…”

Section: Evidence For a Graft Vs Dlbcl Effectmentioning

confidence: 99%

Allogeneic hematopoietic cell transplantation for diffuse large B cell lymphoma: who, when and how?

Klyuchnikov

Bacher

Kroll

et al. 2013

Bone Marrow Transplant

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Despite overall improvements in outcomes of patients with diffuse large B cell lymphoma (DLBCL), B30-40% of patients develop relapsed or refractory disease. For patients with chemo refractory disease, or recurrent disease following autologous hematopoietic SCT (auto-HCT), the prognosis is poor, with no consensus on the optimal therapy. Currently, owing to the graft vs lymphoma effect, hematopoietic allogeneic hematopoietic cell transplantation (allo-HCT) is the only potentially curative option for such patients. In addition, many patients who are considered today for auto-HCT actually have a low likelihood of benefit. For example, a patient with prior rituximab exposure who relapses within 1 year of diagnosis and has a second-line age-adjusted International Prognosis Index of 2 or 3 at relapse has a o25% chance of being cured by auto-HCT. It is possible that such patients may be better served with an allo-HCT. Unfortunately, in many cases, allo-HCT applicability is limited by patient age, comorbidities, performance status and treatment-related toxicities. Recent attempts to improve the efficacy of auto-HCT, such as incorporating radio-immunotherapy into the conditioning regimen, have not resulted in improved outcomes. However, incorporation of novel agents such as antiprogrammed death-1 antibodies as maintenance therapy after auto-HCT show promise. Allo-HCT in relapsed/refractory DLBCL patients can result in a 30-40% PFS rate at 3 years, in part due to a graft vs DLBCL effect. While reduced-intensity/nonmyeloablative conditioning is increasingly being used, certain patients may benefit from myeloablative conditioning. We present an algorithm intended to discriminate which relapsed and refractory DLBCL patients are most likely to benefit from auto-HCT vs allo-HCT. New approaches, using novel agents that target the molecular heterogeneity in DLBCL, will be an essential component of moving the field forward. Lastly, we propose a prospective registry-based study as the only feasible mechanism to define the optimal position of allo-HCT in the overall treatment strategy for DLBCL. It is hoped that this review will promote the development of prospective multicenter efforts to determine whether such patients do, in fact, benefit from earlier and/or more effective implementation of allo-HCT.

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Section: Evidence For a Graft Vs Dlbcl Effectmentioning

confidence: 99%

Allogeneic hematopoietic cell transplantation for diffuse large B cell lymphoma: who, when and how?

Klyuchnikov

Bacher

Kroll

et al. 2013

Bone Marrow Transplant

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“…26 Furthermore, reduced-intensity conditioning regimens allow allogeneic transplantation of a broader group of patients, and available data suggest that durable responses may be achieved in a substantial proportion of patients with relapsed or refractory MCL, suggesting that MCL is subject to potent GVL effects. 14,[27][28][29][30] Historically, MCL has been characterized by relatively brief remissions and short survival times relative to other non-Hodgkin's lymphoma subtypes. The developments of more aggressive induction chemotherapy regimens and monoclonal antibody therapy and advances in both transplantation and supportive care have improved the outlook for patients with MCL.…”

Section: Discussionmentioning

confidence: 99%

“…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: 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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“…Using donor lymphocyte infusions for GVL effect in patients undergoing allogeneic transplantation with RIC or NMA regimens, low transplant mortality rates (<10%) and higher OS (73 to 85%) and EFS rates (73 to 82%) can be achieved 105,117,118 . …”

Section: Reduced Intensity Allogeneic Stem Cell Transplantationmentioning

confidence: 99%

“…In the allogeneic transplant setting, benefit of cure over transplant related mortality can be positively affected by using reduced intensity (RIC) or non-myeloablative (NMA) conditioning regimens [105][106][107][108][109][110][111][112][113][114][115][116] . Using donor lymphocyte infusions for GVL effect in patients undergoing allogeneic transplantation with RIC or NMA regimens, low transplant mortality rates (<10%) and higher OS (73 to 85%) and EFS rates (73 to 82%) can be achieved 105,117,118 .…”

Section: Reduced Intensity Allogeneic Stem Cell Transplantationmentioning

confidence: 99%

Mantle Cell Lymphoma: Decision Making for Transplant

Koç¹,

Demirer²

2012

New Advances in Stem Cell Transplantation

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Nonablative Allogeneic Stem-Cell Transplantation for Advanced/Recurrent Mantle-Cell Lymphoma

Abstract: Our data suggest that nonablative allogeneic transplantation is a safe and potentially effective strategy for patients with relapsed and chemosensitive mantle-cell lymphoma.

Cited by 195 publications

References 16 publications

Allogeneic hematopoietic cell transplantation for diffuse large B cell lymphoma: who, when and how?

Allogeneic hematopoietic cell transplantation for diffuse large B cell lymphoma: who, when and how?

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

Mantle Cell Lymphoma: Decision Making for Transplant

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