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Author Notes:

Correspondence to: Mohamed L. Sorror, M.D., Clinical Research Division (D1-100), Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Seattle, WA 98109-1024, Telephone: 206-667-2765, Fax: 206-667-6124, Email:msorror@fredhutch.org

MLS and DGM designed the study; MLS and JV collected data for the study; TTC, RTM, MAP, PH, GGL, MM, GNF, EA, AL, AR, RS, BMS and DGM coordinated the study at their respective centers; BS contributed to study design and performed statistical analyses; JV, MLS, TTC, PH, GGL, MM, GNF, EA, AL, AR, RS, BMS and DGM contributed to interpretation of results; JV and MLS drafted the manuscript; and TTC, PH, GGL, MM, GNF, EA, AL, AR, RS, BMS, and DGM edited the manuscript.

We are grateful to Michelle Bouvier, RN, and the nonmyeloablative transplant team for their help in study coordination.

We would like to thank Bonnie Larson and Helen Crawford for their assistance with manuscript preparation.

We are grateful to the many physicians, nurses, research nurses, physician assistants, nurse practitioners, pharmacists, data coordinators, and support staff who cared for our patients, and to the patients who allowed us to care for them and who participated in our ongoing clinical research.

The authors have no conflicts of interest to report.

Subjects:

Research Funding:

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:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • conditioning regimen
  • long-term follow-up
  • mantle cell lymphoma
  • nonmyeloablative conditioning
  • stem cell transplantation
  • NON-HODGKINS-LYMPHOMA
  • VERSUS-HOST-DISEASE
  • REDUCED-INTENSITY
  • MARROW TRANSPLANTATION
  • MOLECULAR REMISSIONS
  • CLINICAL-TRIAL
  • FOLLOW-UP
  • BLOOD
  • GRAFT
  • MALIGNANCY

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

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Journal Title:

Cancer

Volume:

Volume 121, Number 20

Publisher:

, Pages 3709-3716

Type of Work:

Article | Post-print: After Peer Review

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.

Copyright information:

© 2015 American Cancer Society.

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