Stem cell transplant for mantle cell lymphoma in Taiwan

Abstract

Mantle cell lymphoma (MCL) is a B-cell lymphoma featuring an aggressive course and a progressive relapsing pattern. International guidelines recommend early consolidative autologous stem cell transplant (auto-SCT) for eligible patients while reserving allogeneic SCT (allo-SCT) as therapy for refractory cases. Since data describing the implementation of transplants in the Asian population with MCL are limited, we aimed to analyze post-SCT outcomes of 99 MCL patients from the Taiwan Bone Marrow Transplant Registry database. The median age was 56 years, and 11% of the patients had blastoid variant MCL. Ninety-four patients received auto-SCT, while 13 patients received allo-SCT, eight of which received allo-SCT after failing auto-SCT. Before auto-SCT, 52% of the patients were in their first complete remission (CR1). Overall, 37 patients (39%) relapsed after auto-SCT. The median post-auto-SCT progression-free survival and overall survival (OS) were 43.6 months and not reached, respectively. Blastoid variant MCL, transplant not received in CR1, and disease progression within 12 months post-auto-SCT independently predicted inferior OS in multivariable analysis. The median post-allo-SCT OS was 74 months. Two patients (15%) died of MCL recurrence post-allo-SCT. Three patients with refractory diseases were salvaged with ibrutinib or venetoclax to allo-SCT. Treatment strategies incorporating novel agents warrant further optimization.

Figure 1

Kaplan–Meier plots of MCL patients receiving autologous (auto-) or allogeneic stem cell transplant (allo-SCT). (a) Progression-free survival (PFS) and overall survival (OS) of 86 patients receiving auto-SCT only (ASCT1) and 8 patients receiving auto-SCT and subsequent allo-SCT due to post-auto-SCT relapse (ASCT2). OS of ASCT2 patients were censored at the time of allo-SCT. (b) PFS and OS of 13 MCL patients receiving allo-SCT.

Figure 2

Kaplan–Meier plots stratified by morphologic variant of MCL. (a) PFS and (b) OS of 94 MCL patients with blastoid or non-blastoid variant. Patients with blastoid variant had significantly inferior PFS and OS.

Figure 3

Kaplan–Meier plots stratified by disease status before autologous stem cell transplant. (a) PFS and (b) OS of patients with different disease status before receiving transplant. Patients receiving transplant at their CR1 state had better PFS and OS.

Figure 4

Kaplan–Meier plots stratified by progression of disease post-auto-SCT or not. (a) Patients who had progression of disease within 24 months (POD24) post-auto-SCT had a significantly shorter survival. (b) POD12 also predicted an inferior post-auto-SCT outcome.