Jennifer E Vaughn1,2, Mohamed L Sorror1,2, Barry E Storer3,4, Thomas R Chauncey1,2,5, Michael A Pulsipher6,7, Richard T Maziarz8, Michael B Maris9, Parameswaran Hari10, Ginna G Laport11, Georg N Franke12, Edward D Agura13, Amelia A Langston14,15, Andrew R Rezvani11, Rainer Storb1,2, Brenda M Sandmaier1,2, David G Maloney1,2. 1. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington. 2. Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington. 3. Clinical Statistics Program, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington. 4. Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington. 5. Marrow Transplant Unit, VA Puget Sound Health Care System, Seattle, Washington. 6. Pediatric Blood and Marrow Transplant Program, Primary Children's Hospital, Salt Lake City, Utah. 7. Division of Hematology/Hematological Malignancies, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah. 8. Center for Hematologic Malignancies, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon. 9. Colorado Blood Cancer Institute, Denver, Colorado. 10. Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin. 11. Division of Blood and Marrow Transplantation, Department of Medicine, Stanford School of Medicine, Stanford, California. 12. Division of Hematology, Oncology, and Hemostaseology, Department of Medicine, University of Leipzig, Leipzig, Germany. 13. Hematopoietic Stem Cell Program, Baylor University School of Medicine, Dallas, Texas. 14. Division of Hematology-Oncology, Emory University School of Medicine, Atlanta, Georgia. 15. Bone Marrow & Stem Cell Transplant Center, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Abstract
BACKGROUND: Previously, early results were reported for allogeneic hematopoietic cell transplantation (HCT) after nonmyeloablative conditioning with 2 Gy of total body irradiation with or without fludarabine and/or rituximab in 33 patients with mantle cell lymphoma (MCL). METHODS: This study examined the outcomes of 70 patients with MCL and included extended follow-up (median, 10 years) for the 33 initial patients. Grafts were obtained from human leukocyte antigen (HLA)-matched, related donors (47%), unrelated donors (41%), and HLA antigen-mismatched donors (11%). RESULTS: The 5-year incidence of nonrelapse mortality was 28%. The relapse rate was 26%. The 5-year rates of overall survival (OS) and progression-free survival (PFS) were 55% and 46%, respectively. The 10-year rates of OS and PFS were 44% and 41%, respectively. Eighty percent of surviving patients were off immunosuppression at the last follow-up. The presence of relapsed or refractory disease at the time of HCT predicted a higher rate of relapse (hazard ratio [HR], 2.94; P = .05). Despite this, OS rates at 5 (51% vs 58%) and 10 years (43% vs 45%) were comparable between those with relapsed/refractory disease and those undergoing transplantation with partial or complete remission. A high-risk cytomegalovirus (CMV) status was the only independent predictor of worse OS (HR, 2.32; P = .02). A high-risk CMV status and a low CD3 dose predicted PFS (HR, 2.22; P = .03). CONCLUSIONS: Nonmyeloablative allogeneic HCT provides a long-term survival benefit for patients with relapsed MCL, including those with refractory disease or multiple relapses.
BACKGROUND: Previously, early results were reported for allogeneic hematopoietic cell transplantation (HCT) after nonmyeloablative conditioning with 2 Gy of total body irradiation with or without fludarabine and/or rituximab in 33 patients with mantle cell lymphoma (MCL). METHODS: This study examined the outcomes of 70 patients with MCL and included extended follow-up (median, 10 years) for the 33 initial patients. Grafts were obtained from human leukocyte antigen (HLA)-matched, related donors (47%), unrelated donors (41%), and HLA antigen-mismatched donors (11%). RESULTS: The 5-year incidence of nonrelapse mortality was 28%. The relapse rate was 26%. The 5-year rates of overall survival (OS) and progression-free survival (PFS) were 55% and 46%, respectively. The 10-year rates of OS and PFS were 44% and 41%, respectively. Eighty percent of surviving patients were off immunosuppression at the last follow-up. The presence of relapsed or refractory disease at the time of HCT predicted a higher rate of relapse (hazard ratio [HR], 2.94; P = .05). Despite this, OS rates at 5 (51% vs 58%) and 10 years (43% vs 45%) were comparable between those with relapsed/refractory disease and those undergoing transplantation with partial or complete remission. A high-risk cytomegalovirus (CMV) status was the only independent predictor of worse OS (HR, 2.32; P = .02). A high-risk CMV status and a low CD3 dose predicted PFS (HR, 2.22; P = .03). CONCLUSIONS: Nonmyeloablative allogeneic HCT provides a long-term survival benefit for patients with relapsed MCL, including those with refractory disease or multiple relapses.
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