Non-myeloablative allogeneic hematopoietic stem cell transplantation for adults with relapsed and refractory mantle cell lymphoma: A single-center analysis in the rituximab era Journal Article
| Authors: | Mussetti, A.; Devlin, S. M.; Castro-Malaspina, H. R.; Barker, J. N.; Giralt, S. A.; Zelenetz, A. D.; Sauter, C. S.; Perales, M. A. |
| Article Title: | Non-myeloablative allogeneic hematopoietic stem cell transplantation for adults with relapsed and refractory mantle cell lymphoma: A single-center analysis in the rituximab era |
| Abstract: | Relapsed and refractory (rel/ref) mantle cell lymphoma (MCL) portend a dismal prognosis. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) represents the only potentially curative therapy in this setting. We analyzed the survival outcomes of 29 recipients of non-myeloablative allo-HSCT for rel/ref MCL, and studied possible prognostic factors in this setting. The cumulative incidences of disease progression and non-relapse mortality at 3 years were 28% (95% confidence interval (CI): 13-46%) and 29% (95% CI: 13-47%), respectively. The cumulative incidence of grade II-IV acute GvHD at days +100 and +180 was 34% (95% CI: 18-52%) and 45% (95% CI: 26-62%), respectively. With a median follow-up in survivors of 53 (range 24-83) months, the 3-year overall survival (OS) and PFS were 54% (95% CI: 38-76%) and 41% (95% CI: 26-64%), respectively. In vivo T-cell depletion with alemtuzumab (n=6) was associated with inferior 3-year PFS (0% vs 51%, P=0.007) and OS (17% vs 64%, P=0.014). Conversely, a second-line international prognostic index (sIPI) at transplantation equal to 0 (no risk factors) was associated with an improved 3-year PFS (52% vs 22%, P=0.020) and OS (71% vs 22%, P=0.006) compared with sIPI ≥1. Performing an allo-HSCT before 2007 was associated with a decreased 3-year OS (25% vs 76%, P=0.015) but not with a significantly inferior PFS (17% vs 59%, P=0.058). In this single-center series, we report encouraging results with allo-HSCT for patients with rel/ref MCL. High alemtuzumab doses should probably be avoided in this context. © 2015 Macmillan Publishers Limited. |
| Keywords: | adult; cancer survival; clinical article; controlled study; aged; survival rate; overall survival; fludarabine; cancer combination chemotherapy; drug efficacy; rituximab; outcome assessment; progression free survival; mantle cell lymphoma; cyclophosphamide; melphalan; cancer mortality; survival time; acute graft versus host disease; allogeneic hematopoietic stem cell transplantation; clinical effectiveness; t cell depletion; alemtuzumab; nonmyeloablative stem cell transplantation; phase 2 clinical trial (topic); survival prediction; cancer prognosis; human; male; female; priority journal; article; relapsed and refractory mantle cell lymphoma |
| Journal Title: | Bone Marrow Transplantation |
| Volume: | 50 |
| Issue: | 10 |
| ISSN: | 0268-3369 |
| Publisher: | Nature Publishing Group |
| Date Published: | 2015-10-01 |
| Start Page: | 1293 |
| End Page: | 1298 |
| Language: | English |
| DOI: | 10.1038/bmt.2015.156 |
| PROVIDER: | scopus |
| PUBMED: | 26146802 |
| PMCID: | PMC4935530 |
| DOI/URL: | |
| Notes: | Export Date: 2 November 2015 -- Source: Scopus |
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