Outcomes of autologous and allogeneic blood or marrow transplantation for mantle cell lymphoma

Abstract

To evaluate high-dose therapy and autologous or allogeneic blood or marrow transplantation (BMT) for mantle cell lymphoma, patients receiving BMT for newly diagnosed or relapsed mantle cell lymphoma were identified through the registry at Johns Hopkins. The pathologic diagnostic criteria were reviewed, and details of the presentation, transplant procedure, and survival outcomes were determined. Fifty-eight patients were identified, of whom 64% underwent transplantation in first remission and 12% had primary induction failure. Nineteen patients (one third) received an allograft. Preparative regimens consisted of cyclophosphamide in combination with either busulfan or total body irradiation. On multiple regression analysis, transplantation after 1 or more relapses (hazard ratio, 2.98; P = .02), primary induction failure (hazard ratio, 5.39; P = .002), and allogeneic transplantation (hazard ratio, 3.03; P = .007) were associated with an inferior event-free survival (EFS). However, EFS curves were not statistically different for autologous and allogeneic BMT performed in first remission, with an estimated 3-year EFS approaching or equaling 70%. Primary induction failure and residual bone marrow involvement were the only statistically significant predictors of relapse on multiple regression analysis. At 3 years, the estimated EFS for the entire cohort after BMT was 51%, the probability of relapse was 31%, and the overall survival was 59%. The benefit of autologous or allogeneic BMT for mantle cell lymphoma is thus most apparent when transplantation is performed in first remission. Whether allogeneic BMT ultimately confers an advantage because of a graft-versus-lymphoma effect remains to be determined.

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

“…The literature supports the performance of autologous HPCT in CR1, 12,13 but the limited follow-up in most published series precludes the determination of long-term benefit. Our median follow-up is 64 months (20-142 months) from diagnosis and 56 months (13-125 months) from transplant and is the longest follow-up to date for patients who received autologous HPCT.…”

“…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.…”

Initial therapy of mantle cell lymphoma

“…An analysis of allogeneic transplant versus ASCT in first remission at Johns Hopkins University revealed no difference in EFS estimated at 70% at 3 years [Kasamon et al 2005]. A comparison of ASCT and allogeneic transplant for 97 patients with MCL at various points in the disease course at the University of Nebraska Medical Center revealed similar 5-year EFS (39% versus 44%) and 5-year OS (47% versus 49%) due to a higher TRM rate for allogeneic transplant (day 100 19% versus 0%) offsetting a lower relapse rate (21% versus 56%) [Ganti et al 2005].…”

Mantle Cell Lymphoma: Decision Making for Transplant

“…Multiply relapsed patients will not do well after autologous transplants 91,103 . Best time to perform an autologous transplant is following CR 91, 92, 119, 120 obtained after high-dose therapy with hyperCVAD or HDS regimen, coupled with rituximab 91 , including in vivo purging prior to stem cell collection 81,92,96 .…”

“…A healthy comparison of autologous and allogeneic transplants cannot be made at present, due to lack of randomized trials and the different prognostic groups undergoing each transplant type. By using myeloablative regimens for relapsed patients, allogeneic transplants can induce three year event free survivals (EFS)around 50% 99,[101][102][103][104] . However, if performed in first CR or PR, EFS induced by allo transplants at three years can be as high as 70% 103 .…”