Abstract
Mantle cell lymphoma (MCL) is a non-Hodgkin’s lymphoma with an often aggressive course, incurable by chemotherapy. Consolidation with high-dose therapy and autologous stem cell transplantation (autoSCT) has a low transplant-related mortality but does not lead to a survival plateau. Allogeneic stem cell transplantation (alloSCT) is associated with a higher early mortality, but can cure MCL. To investigate alloSCT for therapy of MCL, we conducted two prospective trials for de novo MCL (OSHO#74) and for relapsed or refractory MCL (OSHO#60). Fifteen and 24 patients were recruited, respectively. Induction was mainly R-DHAP alternating with R-CHOP. Conditioning was either Busulfan/Cyclophosphamide or Treosulfan/Fludarabin. Either HLA-identical siblings or matched-unrelated donors with not more than one mismatch were allowed. ATG was mandatory in mismatched or unrelated transplantation. Progression-free survival (PFS) was 62% and overall survival (OS) was 68% after 16.5-year follow-up. Significant differences in PFS and OS between both trials were not observed. Patients below 56 years and patients after myeloablative conditioning had a better outcome compared to patients of the corresponding groups. Nine patients have died between day +8 and 5.9 years after SCT. Data from 7 long-term surviving patients showed an excellent Quality-of-life (QoL) after alloSCT. AlloSCT for MCL delivers excellent long-term survival data. The early mortality is higher than after autoSCT; however, the survival curves after alloSCT indicate the curative potential of this therapy. AlloSCT is a standard of care for all feasible patients with refractory or relapsed MCL and should offer to selected patients with de novo MCL and a poor risk profile. For defining the position of alloSCT in the therapeutic algorithm of MCL therapy, a randomized comparison of autoSCT and alloSCT is mandatory.
Highlights
The introduction of rituximab, cis-platinum, and high-dose Ara-C into therapy protocols for mantle cell lymphoma (MCL) is landmark in the improvement of outcome and prognosis of these patients [1,2,3]
Results of High-dose therapy (HDT)+autologous stem cell transplantation (autoSCT) in non-first remission are inferior to those obtained in the first remission [8, 9]
AlloSCT is the therapy of choice for eligible patients in higher remissions but the use of HDT+ autoSCT as consolidation therapy in the first remission is discussed controversially [8]
Summary
The introduction of rituximab, cis-platinum, and high-dose Ara-C into therapy protocols for mantle cell lymphoma (MCL) is landmark in the improvement of outcome and prognosis of these patients [1,2,3]. No patient had a history of high-dose therapy followed by autologous stem cell transplantation. *No patient had a history of high-dose therapy followed by autologous stem cell transplantation prior to inclusion into trials #060 and #074 for each group
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