Evaluating front-line allogeneic stem cell transplantation for mantle cell lymphoma

This study evaluated the outcomes of patients with mantle cell lymphoma (MCL) after front-line (primary) allogeneic stem cell transplantation (alloSCT). This study concluded that front-line alloSCT is effective in these patients.

Chemoimmunotherapy containing rituximab (Rituxan) is the typical front-line treatment for MCL. However, most patients relapse after treatment and need alternative therapies. AlloSCT is commonly used for patients with MCL who relapse after first-line therapy. AlloSCT involves replacing the patient’s cancer cells with healthy stem cells from a donor. Chemotherapy called a conditioning regimen is given first to get rid of any remaining cancer cells. Reduced-intensity regimens have been associated with fewer side effects and improved survival.

The effectiveness of reduced-intensity chemotherapy plus alloSCT as a front-line treatment in patients with MCL remains under investigation.

This study involved 25 patients with MCL. All patients received reduced-intensity chemotherapy before undergoing alloSCT. Patients were followed-up for an average of 60.5 months.

At the time of alloSCT, 44% of patients had complete disappearance of all signs of cancer. 56% of patients had tumor shrinkage. 

At follow-up, the average progression-free survival (time from treatment until tumor growth or spread; PFS) was 68.8 months. At 2 years, 68% of patients were alive without disease progression. At 5 years, this rate was 56%. Two-year overall survival (patients still alive 2 years later) was 80%. At 5 years, this rate was 75.8%. At 2 years, 21% of patients had experienced relapse.

Severe or life-threatening side effects were reported. The most common of these included infections (50%) and mouth sores or painful gums (25%). 38% of patients experienced mild to moderate graft-versus-host disease (the donated stem cells attack the patient’s healthy cells; GVHD). 58% of patients experienced long-lasting GVHD.

This study concluded that front-line alloSCT is effective for patients with MCL. The authors suggest that this treatment should only be considered for patients with a high risk of disease progression after conventional therapy.

The patient population in this study was small. Larger studies and with a comparison group are needed to confirm these results.