Which patients with mantle cell lymphoma may benefit from stem cell therapy?

This article reviewed which patients with mantle cell lymphoma benefitted most from a stem cell transplant.

Mantle cell lymphoma (MCL) is a rare type of non-Hodgkin's lymphoma. It can be challenging to treat. There is no single standard treatment for patients with MCL. However, for young and fit patients, intensive chemotherapy followed by a stem cell transplant (SCT) is usually recommended.

Intensive chemotherapy is given first to get rid of any remaining cancer cells. Then, healthy blood cells are removed from the patient. These cells are given back to the patient to help generate new healthy cells. SCT has been very successful in other types of non-Hodgkin's lymphoma. However, which groups of patients with MCL benefit the most from SCT is unclear.

Most patients with MCL begin treatment with intensive chemoimmunotherapy. This type of treatment combines chemotherapy with immunotherapy agents such as rituximab (Rituxan). One of the most common regimens is R-CHOP. Then, some patients undergo SCT. Many different factors can determine which patients are good candidates for SCT. These can include age, disease symptoms, and if a patient has other medical conditions such as heart disease.

Some studies suggest that specific chemotherapy regimens alone can increase survival. These intense regimens contain an agent called cytarabine (Ara-C). This chemotherapy drug blocks cancer cell growth. In one study, 97 patients received R-HyperCVAD chemotherapy without SCT. 3 years later, 82% of all patients were still alive, and 64% were cancer-free. In another study, patients who had R-HyperCVAD without SCT survived longer than patients who had R-CHOP and SCT (4.0 years vs. 3.2 years). 

Certain features of cancer cells may be associated with poor outcomes. One of these is a genetic mutation called p53. In one study of 183 patients, patients with p53 mutations survived for an average of 1.8 years. Another characteristic is the type of cancer cell. Blastoid cancer cells are particularly aggressive. These cells also have more p53 mutations. 

New targeted therapies may be more effective than SCT for some patients. In one study, 487 patients with MCL were not good candidates for SCT. These patients received either R-CHOP or VR-CAP chemotherapy. VR-CAP contains bortezomib, a type of targeted therapy. On average, patients treated with VR-CAP survived for longer than patients given R-CHOP (90.7 months vs. 55.7 months).

This article reviewed which patients with mantle cell lymphoma benefitted most from a stem cell transplant. The authors suggest that SCT can help delay tumor growth or spread for some patients with MCL. New targeted therapies may also be used with or without SCT to improve outcomes for these patients.

Talk to your doctor about your treatment options to decide whether SCT may be right for you.