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Effectiveness and tolerability of first-line autologous stem cell transplant and maintenance rituximab for mantle cell lymphoma

Bone Marrow Transplantation volume 53, pages 347–351 (2018)Cite this article

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Mantle cell lymphoma (MCL) is an aggressive B-cell lymphoma accounting for 6–10% of non-Hodgkin lymphoma, characterized by the chromosomal translocation t(11;14)(q13;q32), de-regulated expression of cyclin D1 [1], and median overall survival (OS) of 5–7 years [2]. First-line high-dose chemotherapy (HDT) followed by autologous stem cell transplant (ASCT) has been reported to improve patient outcomes [3, 4]. Since relapse remains the main cause of treatment failure, the benefit of post-ASCT rituximab maintenance (RM) has been investigated.

We conducted a retrospective analysis of consecutive fit, younger patients with symptomatic MCL undergoing ASCT at Princess Margaret Cancer Centre (January 2000–March 2014), to determine the impact of the choice of induction therapy and the use of RM on long-term outcome. This study was approved by the Research Ethics Board of the University Health Network/Princess Margaret Cancer Centre. Patients received first-line induction therapy with six cycles of cyclophosphamide, vincristine, doxorubicin, prednisone (CHOP), rituximab + CHOP (R-CHOP), or R-CHOP alternating with rituximab, dexamethasone, cytarabine, cisplatin (R-DHAP; R-CHOP/R-DHAP), followed by ASCT, with or without total body irradiation (TBI). Rituximab was approved as part of combination chemotherapy for MCL in Ontario in 2003, and RM was approved in 2006. Therefore, rituximab was incorporated into pre- and post-ASCT management at these time points. Before 2006 patients received no maintenance, while after this date, RM was offered to all patients unless contraindicated. MCL diagnosis was confirmed according to current criteria [5]. All histopathologic subtypes were eligible. Patients had to meet typical eligibility criteria for ASCT (age ≤ 65 years, stage II–IV disease, performance status ECOG 0–1 at time of transplantation, no significant medical comorbidity).

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Authors and Affiliations

  1. Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, and Department of Medicine, University of Toronto, Toronto, ON, Canada

    Umberto Falcone, Vishal Kukreti, Armand Keating, Michael Crump & John Kuruvilla

  2. Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada

    Haiyan Jiang & Shaheena Bashir

  3. Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada

    Richard Tsang

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  1. Umberto Falcone
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Correspondence to John Kuruvilla.

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Falcone, U., Jiang, H., Bashir, S. et al. Effectiveness and tolerability of first-line autologous stem cell transplant and maintenance rituximab for mantle cell lymphoma. Bone Marrow Transplant 53, 347–351 (2018). https://doi.org/10.1038/s41409-017-0054-8

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