Long term outcome of patients with mantle cell lymphoma following autologous stem cell transplantation

Abstract

6660 Background: Mantle cell lymphoma (MCL) is considered incurable with conventional chemotherapy. The role of autologous hematopoietic stem cell transplantation (ASCT) in treating patients with MCL remains controversial. Methods: We reviewed the outcome of patients undergoing ASCT as part of treatment protocols at Dana-Farber Cancer Institute and Brigham and Women’s Hospital from September 1984 through December 2002. For the purposes of this analysis, progression free survival (PFS) is defined as time from transplant (date of cell infusion) to progression or death in remission. Patients alive in remission were censored. Overall survival (OS) was defined as time from transplant to death. Patients last known to be alive were censored. Results: Thirty patients underwent ASCT after cyclophosphamide and total body irradiation (Cy/TBI) while 7 patients received BCNU, etoposide, cyclophosphamide (CBV) conditioning. One patient was in first complete remission (CR1), 3 were in CR2, 1 was in CR3 and 7 were in first partial remission (PR). The remaining 25 patients were in second or greater PR. No patient underwent ASCT with refractory disease. Thirty patients received stem cell grafts that were purged with anti-B cell antibodies in combination with rabbit complement (28) or immunomagnetic beads (2). Following ASCT, the median PFS and OS were 28 months and 46.3 months, respectively. The median PFS and OS following ASCT for patients with relapsed disease were 20.6 and 45.4 months respectively. Of the 8 patients transplanted in first remission (PR or CR), all have relapsed and 6 have died with a median PFS of 40.8 months and a median OS of 89.5 months. 4 patients developed therapy related myelodysplastic syndrome or acute myelogenous leukemia and all had received previous TBI. Conclusions: ASCT can achieve prolonged remissions in MCL but there is no evidence of a plateau in the PFS curve. The subset of patients transplanted in first remission appear to have superior PFS and OS as compared to conventional therapy, however all eventually relapsed. Newer approaches to ASCT and the use of allogeneic transplantation may improve the outcome for patients with MCL. No significant financial relationships to disclose.