Survival Outcomes of Younger Patients With Mantle Cell Lymphoma Treated in the Rituximab Era

Abstract

Purpose: Mantle cell lymphoma (MCL) is a B-cell lymphoma characterized by cyclin D1 expression. Autologous hematopoietic cell transplantation (AHCT) consolidation after induction chemotherapy is often used for eligible patients; however, the benefit remains uncertain in the rituximab era. Herein we retrospectively assessed the impact of AHCT consolidation on survival in a large cohort of transplantation-eligible patients age 65 years or younger.

Patients and methods: We retrospectively studied transplantation-eligible adults age 65 years or younger with newly diagnosed MCL treated between 2000 and 2015. The primary objective was to assess for improved progression-free survival (PFS) with AHCT consolidation and secondarily to assess for improved overall survival (OS). Cox multivariable regression analysis and propensity score-weighted (PSW) analysis were performed.

Results: Data were collected from 25 medical centers for 1,254 patients; 1,029 met inclusion criteria. Median follow-up for the cohort was 76 months. Median PFS and OS were 62 and 139 months, respectively. On unadjusted analysis, AHCT was associated with improved PFS (75 v 44 months with v without AHCT, respectively; P < .01) and OS (147 v 115 months with v without AHCT, respectively; P < .05). On multivariable regression analysis, AHCT was associated with improved PFS (hazard ratio [HR], 0.54; 95% CI, 0.44 to 0.66; P < .01) and a trend toward improved OS (HR, 0.77; 95% CI, 0.59 to 1.01; P = .06). After PSW analysis, AHCT remained associated with improved PFS (HR, 0.70; 95% CI, 0.59 to 0.84; P < .05) but not improved OS (HR, 0.87; 95% CI, 0.69 to 1.1; P = .2).

Conclusion: In this large cohort of younger, transplantation-eligible patients with MCL, AHCT consolidation after induction was associated with significantly improved PFS but not OS after PSW analysis. Within the limitations of a retrospective analysis, our findings suggest that in younger, fit patients, AHCT consolidation may improve PFS.

FIG 1.

CONSORT diagram. allo-HCT, allogeneic hematopoietic cell transplantation; PD, progressive disease; SD, stable disease.

FIG 2.

Kaplan-Meier curves for (A) progression-free survival (PFS) and (B) overall survival (OS) at 6 months and for (C) propensity score–weighted (PSW) PFS and (D) PSW OS at 6 months. AHCT, autologous hematopoietic cell transplantation. (*) Log-rank test.

FIG 3.

Forest plots for (A) progression-free survival (PFS) and (B) overall survival (OS) with autologous hematopoietic cell transplantation (AHCT). CR, complete response; FISH, fluorescence in situ hybridization; MIPI, Mantle Cell Lymphoma International Prognostic Index; PR, partial response.

FIG A1.

Overall survival (OS) of full cohort. Median survival, 76.8 months (6.4 years).

FIG A2.

Overall survival (OS) for patients (A) undergoing or (B) not undergoing autologous hematopoietic cell transplantation (AHCT) by Mantle Cell Lymphoma International Prognostic Index (MIPI) score and for patients (C) by AHCT and receipt of cytarabine and (D) by AHCT and induction regimen. CHOP, cyclophosphamide, doxurobucin, vincristine, and prednisone; NA, not available.

FIG A3.

Overall survival (OS) after progression by second-line transplantation.