Mature results of the M. D. Anderson Cancer Center risk-adapted transplantation strategy in mantle cell lymphoma

Abstract

In this study, we analyzed the long-term outcome of a risk-adapted transplantation strategy for mantle cell lymphoma in 121 patients enrolled in sequential transplantation protocols. Notable developments over the 17-year study period were the addition of rituximab to chemotherapy and preparative regimens and the advent of nonmyeloablative allogeneic stem cell transplantation (NST). In the autologous transplantation group (n = 86), rituximab resulted in a marked improvement in progression-free survival for patients who received a transplant in their first remission (where a plateau emerged at 3-8 years) but did not change the outcomes for patients who received a transplant beyond their first remission. In the NST group, composed entirely of patients who received a transplant beyond their first remission, durable remissions also emerged in progression-free survival at 5 to 9 years. The major determinants of disease control after NST were the use of a peripheral blood stem cell graft and donor chimerism of at least 95%, whereas the major determinant of death was immunosuppression for chronic graft-versus-host disease. Our results show that long-term disease-free survival in mantle cell lymphoma is possible after rituximab-containing autologous transplantation for patients in first remission and after NST for patients with relapsed or refractory disease.

Figure 1

Overall survival and progression-free survival. Overall survival (A) and progression-free survival (B). AUTO1 indicates patients receiving autologous transplant in first remission; AUTO2, patients receiving autologous transplant for relapsed/refractory disease; and NST, patients receiving nonmyeloablative stem cell transplant for relapsed/refractory disease.

Figure 2

Progression-free survival for patients receiving autologous transplantation in first remission and for relapsed/refractory disease. Patients received autologous transplant in first remission (A) and for relapsed/refractory disease (B).

Figure 3

Relapse risk after nonmyeloablative stem cell transplantation by graft source and best chimerism. PBSC indicates peripheral blood stem cell. No relapses have occurred in patients receiving PBSCs and achieving best donor chimerism of 95% or greater.