Evaluating allogeneic stem cell transplantation for patients with mantle cell lymphoma

This study evaluated the effectiveness of an allogeneic stem cell transplant (alloSCT) for patients with mantle cell lymphoma (MCL). The authors concluded that this treatment was effective for high-risk patients.

MCL is an aggressive type of non-Hodgkin lymphoma (NHL). Chemoimmunotherapy is the typical first-line (primary) treatment for patients with MCL. 80 – 90% of patients respond to this treatment. However, many patients eventually have the cancer return (relapse) or stop responding to treatment (refractory). These patients need other treatment options.

One treatment option is alloSCT. Before the transplant, high-dose chemotherapy is given to get rid of any remaining cancer cells. This is called a conditioning regimen. Then, healthy stem cells are collected from a donor and given to the patient. This requires a close tissue type match between the donor and the patient so that the donor’s cells do not attack the patient’s healthy cells. This attack is called GVHD (graft-versus-host disease). The long-term outcomes of patients with MCL after alloSCT remain under investigation.

This study looked at the results of two different studies. One study had 24 patients with newly diagnosed MCL (group A). The other study had 15 patients with relapsed or refractory MCL (group B). Both groups had high-dose chemotherapy followed by alloSCT. 3 patients in group B did not have alloSCT due to disease progression. Patients were followed up for 16.5 years.

After 16.5 years, 68% of all patients were alive and 62% of patients were alive without tumor growth or spread. On average, patients lived for 5.9 years after SCT without disease worsening.

In group A, patients had an average survival of 5.4 years and an average survival without cancer worsening of 5.2 years after treatment. In group B, patients had an average survival of 8.5 years and an average survival without disease worsening of 7.9 years after treatment.

Before the transplant, 7 patients received a stronger chemotherapy regimen (group 1) and 26 patients had a less intense regimen (group 2). Survival without cancer worsening was significantly higher in group 1 compared to group 2 (7.0 years vs. 5.2 years). Overall survival was also higher in group 1 compared to group 2 (7.0 vs. 5.9 years).

After treatment, 15% of all patients experienced chronic GVHD. 

This study concluded that alloSCT was safe and effective for patients with MCL. The authors suggest that alloSCT should also be offered to patients with relapsed or refractory high-risk disease.

This study evaluated the results of two different trials. Each trial had a small number of patients. Larger, more direct studies are needed to confirm these results. Whether autoSCT is more effective than alloSCT for these patients warrants further investigation.