Is stem cell transplantation always necessary for mantle cell lymphoma?

This study reported the long-term outcomes of patients with mantle cell lymphoma treated with intense chemoimmunotherapies, without stem cell transplantation (SCT). This study concluded that this treatment combination, without SCT, was safe and effective.

Mantle cell lymphoma (MCL) is an aggressive form of non-Hodgkin lymphoma. MCL can be difficult to treat. Intense chemotherapy, with or without stem cell (immature blood cell) transplantation (SCT), has been found to be very effective. Rituximab (Rituxan) is a treatment that binds to a protein on cancer cells and leads to cell death. This has also improved outcomes. However, the long-term success of these intensified combinations is still under investigation.

This study reported the 10-year outcomes of patients treated with intensified chemoimmunotherapy. 97 patients with untreated MCL were included in the trial. All patients were treated with R-hyperCVAD, a combination of rituximab and intensified cyclophosphamide, doxorubicin, vincristine, and dexamethasone. This treatment alternated with R-MA (rituximab, high-dose methotrexate, and cytarabine). 97% of patients responded to treatment. 87% achieved complete remission (CR, no sign of disease). Patients were then followed for 10 years.

The average time to treatment failure (time from treatment to disease progression or death) was 4.6 years. The average overall survival (time from treatment until death from any cause) was not reached. For patients younger than 65, the average time to treatment failure was 5.9 years. 64% were expected to be alive longer than 10 years.

Patients with lower risk disease were 55% to 60% less likely to experience treatment failure and had better overall survival. Patients with high beta2-microglobulin levels (a tumor marker in the blood) had an 84% chance of a shorter time to treatment failure.

This study concluded that intense chemoimmunotherapy, without stem cell transplantation, is effective in the long-term for patients with untreated, aggressive MCL.