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. 2008 Jun;49(6):1062-73.
doi: 10.1080/10428190801923725.

Effect of remission status and induction chemotherapy regimen on outcome of autologous stem cell transplantation for mantle cell lymphoma

Brian G Till  1 , Theodore A Gooley, Nathan Crawford, Ajay K Gopal, David G Maloney, Stephen H Petersdorf, John M Pagel, Leona Holmberg, William Bensinger, Oliver W Press
Affiliations

Effect of remission status and induction chemotherapy regimen on outcome of autologous stem cell transplantation for mantle cell lymphoma

Brian G Till et al. Leuk Lymphoma. 2008 Jun.

Abstract

We analysed the outcomes of autologous stem cell transplantation (ASCT) following high-dose therapy with respect to remission status at the time of transplantation and induction regimen used in 56 consecutive patients with mantle cell lymphoma (MCL). Twenty-one patients received induction chemotherapy with HyperCVAD with or without rituximab (+/-R) followed by ASCT in first complete or partial remission (CR1/PR1), 15 received CHOP (+/-R) followed by ASCT in CR1/PR1 and 20 received ASCT following disease progression. Estimates of overall and progression-free survival (PFS) at 3 years among patients transplanted in CR1/PR1 were 93% and 63% compared with 46% and 36% for patients transplanted with relapsed/refractory disease, respectively. The hazard of mortality among patients transplanted with relapsed/refractory disease was 6.09 times that of patients transplanted in CR1/PR1 (P = 0.006). Patients in the CHOP (+/-R) group had a higher risk of failure for PFS compared with patients in the HyperCVAD (+/-R) group, though the difference did not reach statistical significance (hazard ratio 3.67, P = 0.11). These results suggest that ASCT in CR1/PR1 leads to improved survival outcomes for patients with MCL compared to ASCT with relapsed/refractory disease, and a HyperCVAD (+/-R) induction regimen may be associated with an improved PFS among patients transplanted in CR1/PR1.

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Figures

Figure 1
Figure 1
Kaplan-Meier estimates of overall survival, progression free-survival, and relapse for the entire cohort. The probability of survival, progression-free survival, and relapse at 3 years were 72%, 52%, and 45%, respectively.
Figure 2
Figure 2
Kaplan-Meier estimates of overall survival from the time of ASCT, with respect to remission status at ASCT. The estimated 3-year survival for patients treated with ASCT in CR1/PR1 was 93%, compared with 46% in patients who underwent ASCT with relapsed or refractory disease.
Figure 3
Figure 3
Kaplan-Meier estimates of overall survival (A) and progression-free survival (B) from the time of ASCT, with respect to primary comparison group. The estimated 3 year OS and PFS for patients treated with HyperCVAD (±R) followed by ASCT in CR1/PR1 were 94% and 81%, respectively, compared with 92% and 44%, in patients treated with a CHOP (±R) regimen followed by ASCT in CR1/PR1. Patients who received a different induction regimen or underwent ASCT with refractory disease or after relapse had the lowest OS and PFS at 46% and 36%.
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