Total Body Irradiation Is Safe and Similarly Effective as Chemotherapy-Only Conditioning in Autologous Stem Cell Transplantation for Mantle Cell Lymphoma

Abstract

Autologous stem cell transplant (ASCT) consolidation has become a standard approach for patients with mantle cell lymphoma (MCL), yet there is little consensus on the role of total body irradiation (TBI) as part of high-dose transplantation conditioning. We analyzed 75 consecutive patients with MCL who underwent ASCT at our institution between 2001 and 2011 with either TBI-based (n = 43) or carmustine, etoposide, cytarabine, melphalan (BEAM; n = 32) high-dose conditioning. Most patients (97%) had chemosensitive disease and underwent transplantation in first remission (89%). On univariate analysis, TBI conditioning was associated with a trend toward improved PFS (hazard ratio [HR], .53; 95% confidence interval [CI], .28-1.00; P = .052) and similar OS (HR, .59; 95% CI, .26-1.35; P = .21), with a median follow-up of 6.3 years in the TBI group and 6.6 years in the BEAM group. The 5-year PFS was 66% in the TBI group versus 52% in the BEAM group; OS was 82% versus 68%, respectively. However, on multivariate analysis, TBI-based conditioning was not significantly associated with PFS (HR, .57; 95% CI .24-1.34; P = .20), after controlling for age, disease status at ASCT, and receipt of post-transplantation rituximab maintenance. Likewise, early toxicity, nonrelapse mortality, and secondary malignancies were similar in the 2 groups. Our data suggest that both TBI and BEAM-based conditioning regimens remain viable conditioning options for patients with MCL undergoing ASCT.

Long‐term outcome in patients with mantle cell lymphoma following high‐dose therapy and autologous stem cell transplantation

“…In patients with follicular lymphoma secondary malignancies are obviously less frequent after BEAM than after TBI/cyclophosphamide. 44,45 The data of the Nordic Lymphoma Group suggest that the outcome of BEAM or BEAC is comparable with a TBI-containing protocol in MCL, 4 also the data of Tseng et al 46 In our cohort, we found a significantly lower OS after TBI compared to BEAM in the multivariate analysis. This observation should not be overestimated because of our small patient cohort.…”

Bulky primary tibia mantle cell lymphoma achieved complete remission with CHOP and DHAP plus rituximab: A case report

“…According to the last European Society for Medical Oncology guideline, a rituximab containing induction of CHOP and cytarabine followed by ASCT and consolidation is recommended (7). ASCT consolidation is potentially curative and has become a standard approach for patients with MCL (10). Despite the high rate of complete response following systemic chemotherapy followed by ASCT, patients do relapse.…”