Impact of Hematopoietic Stem Cell Transplantation in Patients with Relapsed or Refractory Marginal Zone Lymphoma

Abstract

Introduction Marginal zone lymphoma (MZL) is an indolent lymphoma, which includes extra-nodal MZL of mucosa-associated lymphoid lymphoma (MALToma), nodal MZL (NMZL), and splenic MZL (SMZL). There are currently several treatment options for patients with relapsed or refractory (R/R) MZL, including high-dose chemotherapy with autologous hematopoietic cell transplantation (HCT). Allogeneic HCT is considered to be an optional therapy for R/R MZL patients, but there is no specific data to support allogeneic HCT for R/R MZL. Objectives We retrospectively analyzed the outcomes among R/R MZL patients treated with autologous or allogeneic HCT to identify the potential clinical efficacy of allogeneic HCT. Methods Patient information was derived from the Transplant Registry Unified Management Program database, collected by the Japanese Data Center for Hematopoietic Cell Transplantation, and sponsored by the Japanese Society for Hematopoietic Cell Transplantation. The 70 patients with R/R MZL (25 MALToma, 31 NMZL, and 14 SMZL) were receiving either autologous HCT (n=56, 19 MALToma, 27 NMZL and 10 SMZL) or allogeneic HCT (n=14, 6 MALToma, 4 NMZL and 4 SMZL). Results No patients with MALToma died because of non-relapse mortality (NRM) following autologous HCT and no patients developed relapse with MALToma and NMZL at allogeneic HCT. Progression-free survival (PFS) and overall survival (OS) of R/R SMZL patients who underwent allogeneic HCT were significantly lower compared with the autologous HCT group (median PFS, 65.6% and 25.0% at 1 year after autologous and allogeneic HCT, P=0.014; median OS, 78.7% and 25.0% at 1 year after autologous and allogeneic HCT, P=0.0030). There were no significant differences in the PFS and OS of R/R MALToma and NMZL patients who underwent autologous HCT compared with allogeneic HCT. The main findings of this study indicated that both autologous and allogeneic HCT may be acceptable for patients with chemo-sensitive MALToma and NMZL, but the results of allogeneic HCT for chemo-resistant MALToma and SMZL were inconclusive. Conclusion The parameters for choosing between autologous and allogeneic HCT for R/R MZL have not been defined, and strategies aimed at improving the selection of R/R MZL patients for autologous HCT and excluding R/R chemo-resistant MALToma patients, may allow us to identify individual R/R MZL patients who are at high risk of death after both autologous and allogeneic HCT. Selecting suitable R/R SMZL patients for allogeneic HCT might reduce NRM. The introduction of novel therapies before and after receiving allogeneic HCT could improve outcomes among R/R SMZL patients.