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Lymphoma

Non-myeloablative allogeneic hematopoietic stem cell transplantation for adults with relapsed and refractory mantle cell lymphoma: a single-center analysis in the rituximab era

Bone Marrow Transplantation volume 50, pages 1293–1298 (2015)Cite this article

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Abstract

Relapsed and refractory (rel/ref) mantle cell lymphoma (MCL) portend a dismal prognosis. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) represents the only potentially curative therapy in this setting. We analyzed the survival outcomes of 29 recipients of non-myeloablative allo-HSCT for rel/ref MCL, and studied possible prognostic factors in this setting. The cumulative incidences of disease progression and non-relapse mortality at 3 years were 28% (95% confidence interval (CI): 13–46%) and 29% (95% CI: 13–47%), respectively. The cumulative incidence of grade II–IV acute GvHD at days +100 and +180 was 34% (95% CI: 18–52%) and 45% (95% CI: 26–62%), respectively. With a median follow-up in survivors of 53 (range 24–83) months, the 3-year overall survival (OS) and PFS were 54% (95% CI: 38–76%) and 41% (95% CI: 26–64%), respectively. In vivo T-cell depletion with alemtuzumab (n=6) was associated with inferior 3-year PFS (0% vs 51%, P=0.007) and OS (17% vs 64%, P=0.014). Conversely, a second-line international prognostic index (sIPI) at transplantation equal to 0 (no risk factors) was associated with an improved 3-year PFS (52% vs 22%, P=0.020) and OS (71% vs 22%, P=0.006) compared with sIPI ⩾1. Performing an allo-HSCT before 2007 was associated with a decreased 3-year OS (25% vs 76%, P=0.015) but not with a significantly inferior PFS (17% vs 59%, P=0.058). In this single-center series, we report encouraging results with allo-HSCT for patients with rel/ref MCL. High alemtuzumab doses should probably be avoided in this context.

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Acknowledgements

We gratefully acknowledge the expert care provided to our patients by doctors, fellows, house staff and nurses of Memorial Sloan Kettering Cancer Center. AM received a philanthropic support from Associazione Italiana Contro le Leucemie-Linfomi e Mieloma ONLUS.

Author contributions

CSS and MAP designed the study, AM and SMD analyzed the data. AM, CSS and MAP interpreted the data. AM, HC-M, JNB, SG, ADZ, CSS and MAP wrote the manuscript.

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Author notes

  1. C S Sauter and M-A Perales: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    A Mussetti, H R Castro-Malaspina, J N Barker, S A Giralt, C S Sauter & M-A Perales

  2. Universita’ degli Studi di Milano, Milan, Italy

    A Mussetti

  3. Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    S M Devlin

  4. Weill Cornell Medical College, New York, NY, USA

    S M Devlin, H R Castro-Malaspina, J N Barker, S A Giralt, A D Zelenetz, C S Sauter & M-A Perales

  5. Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    A D Zelenetz

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AM was supported in part by the Associazione Italiana Contro le Leucemie-Linfomi e Mieloma ONLUS. SMD, HC-M, JNB, SG, ADZ, CSS and MAP have nothing to disclose.

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Mussetti, A., Devlin, S., Castro-Malaspina, H. et al. Non-myeloablative allogeneic hematopoietic stem cell transplantation for adults with relapsed and refractory mantle cell lymphoma: a single-center analysis in the rituximab era. Bone Marrow Transplant 50, 1293–1298 (2015). https://doi.org/10.1038/bmt.2015.156

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