Ganti AK et al. (2005) Hematopoietic stem cell transplantation in mantle cell lymphoma. Ann Oncol 16: 618–624

Response rate and overall survival for mantle-cell lymphoma is poor. Multiple chemotherapeutic regimens have been tried, but none show clear superiority. High-dose chemotherapy followed by autologous hematopoietic stem-cell transplantation (HSCT) improves overall survival, although reports suggest this approach is not curative.

Ganti et al. have carried out a single-institute trial to study the course of disease in patients receiving autologous or allogeneic HSCT. Eighty patients received autologous HSCT and 17 received allogeneic HSCT. There were no significant differences in complete remission rates at 100 days, or in estimated five-year event-free and overall survival, between the two groups. The estimated five-year relapse rate was 21% in the allogeneic group and 56% in the autologous group, which might be due to a graft-versus-lymphoma effect or reinfusion of tumor cells, although the authors note that the study may have been underpowered. Three patients in the allogeneic group died compared to none in the autologous group, perhaps reflecting the increased likelihood of those in the allogeneic group to have received radiation therapies.

A subgroup analysis of 33 patients treated after 2000 showed that 10 patients who received hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone (HyperCVAD) ± rituximab before HSCT had no relapses and no deaths, compared to a 30% relapse rate and 4 deaths in the 23 patients who were not treated with HyperCVAD.

The authors conclude that the choice of autologous versus allogeneic stem cells does not affect overall transplant outcome, although the pattern of treatment failure is different, and this may help design future strategies. The authors also note that previous HyperCVAD plus rituximab might optimize results.