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Autologous or reduced-intensity conditioning allogeneic hematopoietic cell transplantation for chemotherapy-sensitive mantle-cell lymphoma: analysis of transplantation timing and modality

Timothy S Fenske, Mei-Jie Zhang, Jeanette Carreras, Ernesto Ayala, Linda J Burns, Amanda Cashen, Luciano J Costa, César O Freytes, Robert P Gale, Mehdi Hamadani, Leona A Holmberg, David J Inwards, Hillard M Lazarus, Richard T Maziarz, Reinhold Munker, Miguel-Angel Perales, David A Rizzieri, Harry C Schouten, Sonali M Smith, Edmund K Waller, Baldeep M Wirk, Ginna G Laport, David G Maloney, Silvia Montoto, Parameswaran N Hari
Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology 2014 February 1, 32 (4): 273-81
24344210

PURPOSE: To examine the outcomes of patients with chemotherapy-sensitive mantle-cell lymphoma (MCL) following a first hematopoietic stem-cell transplantation (HCT), comparing outcomes with autologous (auto) versus reduced-intensity conditioning allogeneic (RIC allo) HCT and with transplantation applied at different times in the disease course.

PATIENTS AND METHODS: In all, 519 patients who received transplantations between 1996 and 2007 and were reported to the Center for International Blood and Marrow Transplant Research were analyzed. The early transplantation cohort was defined as those patients in first partial or complete remission with no more than two lines of chemotherapy. The late transplantation cohort was defined as all the remaining patients.

RESULTS: Auto-HCT and RIC allo-HCT resulted in similar overall survival from transplantation for both the early (at 5 years: 61% auto-HCT v 62% RIC allo-HCT; P = .951) and late cohorts (at 5 years: 44% auto-HCT v 31% RIC allo-HCT; P = .202). In both early and late transplantation cohorts, progression/relapse was lower and nonrelapse mortality was higher in the allo-HCT group. Overall survival and progression-free survival were highest in patients who underwent auto-HCT in first complete response. Multivariate analysis of survival from diagnosis identified a survival benefit favoring early HCT for both auto-HCT and RIC allo-HCT.

CONCLUSION: For patients with chemotherapy-sensitive MCL, the optimal timing for HCT is early in the disease course. Outcomes are particularly favorable for patients undergoing auto-HCT in first complete remission. For those unable to achieve complete remission after two lines of chemotherapy or those with relapsed disease, either auto-HCT or RIC allo-HCT may be effective, although the chance for long-term remission and survival is lower.

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