Medline ® Abstract for Reference 70
of 'Treatment of relapsed or refractory mantle cell lymphoma'
Autologous or reduced-intensity conditioning allogeneic hematopoietic cell transplantation for chemotherapy-sensitive mantle-cell lymphoma: analysis of transplantation timing and modality.
Fenske TS, Zhang MJ, Carreras J, Ayala E, Burns LJ, Cashen A, Costa LJ, Freytes CO, Gale RP, Hamadani M, Holmberg LA, Inwards DJ, Lazarus HM, Maziarz RT, Munker R, Perales MA, Rizzieri DA, Schouten HC, Smith SM, Waller EK, Wirk BM, Laport GG, Maloney DG, Montoto S, Hari PN
J Clin Oncol. 2014 Feb;32(4):273-81. Epub 2013 Dec 16.
PURPOSE: To examine the outcomes of patients with chemotherapy-sensitive mantle-cell lymphoma (MCL) following a first hematopoietic stem-cell transplantation (HCT), comparing outcomes with autologous (auto) versus reduced-intensity conditioning allogeneic (RIC allo) HCT and with transplantation applied at different times in the disease course.
PATIENTS AND METHODS: In all, 519 patients who received transplantations between 1996 and 2007 and were reported to the Center for International Blood and Marrow Transplant Research were analyzed. The early transplantation cohort was defined as those patients in first partial or complete remission with no more than two lines of chemotherapy. The late transplantation cohort was defined as all the remaining patients.
RESULTS: Auto-HCT and RIC allo-HCT resulted in similar overall survival from transplantation for both the early (at 5 years: 61% auto-HCT v 62% RIC allo-HCT; P = .951) and late cohorts (at 5 years: 44% auto-HCT v 31% RIC allo-HCT; P = .202). In both early and late transplantation cohorts, progression/relapse was lower and nonrelapse mortality was higher in the allo-HCT group. Overall survival and progression-free survival were highest in patients who underwentauto-HCT in first complete response. Multivariate analysis of survival from diagnosis identified a survival benefit favoring early HCT for both auto-HCT and RIC allo-HCT.
CONCLUSION: For patients with chemotherapy-sensitive MCL, the optimal timing for HCT is early in the disease course. Outcomes are particularly favorable for patients undergoing auto-HCT in first complete remission. For those unable to achieve complete remission after two lines of chemotherapy or those with relapsed disease, either auto-HCT or RIC allo-HCT may be effective, although the chance for long-term remission and survival is lower.
Timothy S. Fenske and Mehdi Hamadani, Medical College of Wisconsin; Mei-Jie Zhang, Jeanette Carreras, and Parameswaran N. Hari, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Ernesto Ayala, H. Lee Moffitt Cancer Center and Research Institute, Tampa; Baldeep M. Wirk, Shands Healthcare and University of Florida, Gainesville, FL; Linda J. Burns, University of Minnesota Medical Center, Fairview, Minneapolis; David J. Inwards, Mayo Clinic Rochester, Rochester, MN; Amanda Cashen, Barnes Jewish Hospital, Washington University School of Medicine, St. Louis, MO; Luciano J. Costa, Medical University of South Carolina, Charleston, SC; César O. Freytes, South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, TX; Robert P. Gale, Imperial College; Silvia Montoto, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Leona A. Holmberg and David G. Maloney, Fred Hutchinson Cancer Research Center, Seattle, WA; Hillard M. Lazarus, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH; Richard T. Maziarz, Oregon Health and Science University, Portland, OR; Reinhold Munker, Louisiana StateUniversity Health Sciences Center-Shreveport, Shreveport, LA; Miguel-Angel Perales, Memorial Sloan-Kettering Cancer Center, New York, NY; David A. Rizzieri, Duke University Medical Center, Durham, NC; Harry C. Schouten, Academische Ziekenhuis Maastricht, Maastricht, the Netherlands; Sonali M. Smith, University of Chicago Hospitals, Chicago, IL; Edmund K. Waller, Emory University Hospital, Atlanta, GA; and Ginna G. Laport, Stanford Hospital and Clinics, Stanford, CA.