Autologous or Reduced-Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation for Chemotherapy-Sensitive Mantle-Cell Lymphoma: Analysis of Transplantation Timing and Modality Journal Article


Authors: Fenske, T. S.; Zhang, M. J.; Carreras, J.; Ayala, E.; Burns, L. J.; Cashen, A.; Costa, L. J.; Freytes, C. O.; Gale, R. P.; Hamadani, M.; Holmberg, L. A.; Inwards, D. J.; Lazarus, H. M.; Maziarz, R. T.; Munker, R.; Perales, M. A.; Rizzieri, D. A.; Schouten, H. C.; Smith, S. M.; Waller, E. K.; Wirk, B. M.; Laport, G. G.; Maloney, D. G.; Montoto, S.; Hari, P. N.
Article Title: Autologous or Reduced-Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation for Chemotherapy-Sensitive Mantle-Cell Lymphoma: Analysis of Transplantation Timing and Modality
Abstract: 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 underwent auto-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.
Keywords: survival; rituximab; immunochemotherapy; follow-up; phase-ii; prospective randomized-trial; international prognostic index; marrow; transplant; induction regimen; improves response
Journal Title: Journal of Clinical Oncology
Volume: 32
Issue: 4
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2014-02-01
Start Page: 273
End Page: 281
Language: English
ACCESSION: WOS:000331066600004
DOI: 10.1200/jco.2013.49.2454
PROVIDER: wos
PMCID: PMC3897255
PUBMED: 24344210
Notes: Article -- Source: Wos
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  1. Miguel-Angel Perales
    382 Perales