autologous blood and marrow transplantation - Blog Science ...

High-Dose Therapy Followed by
Hematopoietic Stem Cell Transplantation (HSCT)
for Mantle Cell Lymphoma (MCL)
P. Merman, J. Vose, J. Lynch, M. Bishop, J. Malone,
A. Kessinger, J. Armitage
University of Nebraska Medical Center, Omaha, NE
Between June 1991 and January 1998, 46 transplants (autologous, «=39;
allogeneic, n=l\ marrow, «=5; blood, «=41) were performed on 45 patients with
MCL. There were 36 males and 9 females. Median age for autologous patients was
56 years (range 34-65). Currently, 28 patients are alive after autologous transplantation
and 21 have not progressed (median follow-up 12.8 months; range 3-61). At
2 years, overall survival (OS) and event-free survival (EFS) for these patients are
estimated at 65 and 41%, respectively. The actuarial probability of relapse or
progression was 56% at 2 years, and there was no evidence of a plateau in EFS. No
patients died before day 100, although one patient was diagnosed with a
glioblastoma multiforme 18 months after transplantation. Patients with blastic
histology (P=0.023), any history of bone marrow involvement (f=0.008), elevated
LDH (P=0.15), and three or more prior regimens (P=0.001) had significantly worse
EFS. Two patients who had allogeneic transplants died 2 and 12 months later from
pulmonary complications. Neither had evidence of lymphoma at autopsy. There
have been no relapses or progression among the five remaining allogeneic
transplant patients (median follow-up 14.2 months; range 3^45). At 2 years, OS
and EFS are each projected to be 64%. A case-matching analysis failed to show
significant differences in OS or EFS among autologous and allogeneic transplant
recipients. Although long-term EFS was observed after autologous HSCT for
MCL, a continuous pattern of treatment failure was observed, and there is little
evidence that this approach has curative potential. The role of allogeneic transplantation
for MCL should be further explored.
184