Long-Term Sustained Disease Control in Patients With Mantle Cell Lymphoma With or Without Active Disease After Treatment With Allogeneic Hematopoietic Cell Transplantation After Nonmyeloablative Conditioning

• Type of Material: Article
• Authors: Jennifer E. Vaughn, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Fred Hutchinson Cancer Research Center; Barry E. Storer, Fred Hutchinson Cancer Research Center; Thomas R. Chauncey, Fred Hutchinson Cancer Research Center; Michael A. Pulsipher, Primary Children's Hospital; Richard T. Maziarz, OHSU Knight Cancer Institute; Michael B. Maris, Colorado Blood Cancer Institute; Parameswaran Hari, Medical College of Wisconsin; Ginna G. Laport, Stanford University; Georg N. Franke, University of Leipzig; Edward D. Agura, Baylor University; Amelia Langston, Emory University; Andrew Rezvani, Stanford University; Rainer Storb, Fred Hutchinson Cancer Research Center; Brenda M. Sandmaier, Fred Hutchinson Cancer Research Center; David G. Maloney, Fred Hutchinson Cancer Research Center
• Language: English
• Date: 2015-07-24
• Publisher: Wiley-Blackwell
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 American Cancer Society.
• Final Published Version (URL): http://dx.doi.org/10.1002/cncr.29498
• Title of Journal or Parent Work: Cancer
• Volume: 121
• Issue: 20
• Start Page: 3709
• End Page: 3716
• Grant/Funding Information: This study was supported by grants CA018029, CA15704, CA078902, HL088021 and 5T32HL007093-38 from the National Heart Lung Blood Institute, the National Institutes of Health.; M.L.S. is also supported by a Research Scholar Grant No. RSG-13- 084-01-CPHPS from the American Cancer Society; and by Patient-Centered Outcome Research Institute Contract No. CE-1304-7451.
• Keywords: MARROW TRANSPLANTATION; CLINICAL-TRIAL; VERSUS-HOST-DISEASE; Science & Technology; conditioning regimen; NON-HODGKINS-LYMPHOMA; GRAFT; Life Sciences & Biomedicine; BLOOD; REDUCED-INTENSITY; nonmyeloablative conditioning; stem cell transplantation; MOLECULAR REMISSIONS; MALIGNANCY; Oncology; mantle cell lymphoma; long-term follow-up; FOLLOW-UP
• Research Categories: Health Sciences, Oncology; Health Sciences, General; Biology, Cell

Abstract

BACKGROUND Previously, early results were reported for allogeneic hematopoietic cell transplantation (HCT) after nonmyeloablative conditioning with 2 Gy of total body irradiation with or without fludarabine and/or rituximab in 33 patients with mantle cell lymphoma (MCL). METHODS This study examined the outcomes of 70 patients with MCL and included extended follow-up (median, 10 years) for the 33 initial patients. Grafts were obtained from human leukocyte antigen (HLA)-matched, related donors (47%), unrelated donors (41%), and HLA antigen-mismatched donors (11%). RESULTS The 5-year incidence of nonrelapse mortality was 28%. The relapse rate was 26%. The 5-year rates of overall survival (OS) and progression-free survival (PFS) were 55% and 46%, respectively. The 10-year rates of OS and PFS were 44% and 41%, respectively. Eighty percent of surviving patients were off immunosuppression at the last follow-up. The presence of relapsed or refractory disease at the time of HCT predicted a higher rate of relapse (hazard ratio [HR], 2.94; P =.05). Despite this, OS rates at 5 (51% vs 58%) and 10 years (43% vs 45%) were comparable between those with relapsed/refractory disease and those undergoing transplantation with partial or complete remission. A high-risk cytomegalovirus (CMV) status was the only independent predictor of worse OS (HR, 2.32; P =.02). A high-risk CMV status and a low CD3 dose predicted PFS (HR, 2.22; P =.03). CONCLUSIONS Nonmyeloablative allogeneic HCT provides a long-term survival benefit for patients with relapsed MCL, including those with refractory disease or multiple relapses.