Authors: M. Northend, K. Ardeshna, C. McNamara, W. Townsend, K. Cwynarski, S. Mohamedbhai, C. Roddie, A. Virchis, H. Al‐Sader, R. Shah, K. Peggs, D. Linch, J. Lambert
Published: 2023-12-31
DOI: 10.1002/j.2572-9241.2019.tb00087.x
Source: Full article
Background:The introduction of intensive cytarabine‐containing treatment regimens followed by autologous stem cell transplantation (ASCT) has led to substantial improvements in survival for patients with mantle cell lymphoma (MCL). The Nordic MCL2 trial, in which three cycles of Rituximab(R)‐Cytarabine and three cycles of R‐Maxi CHOP were followed by ASCT, reported a median overall survival (OS) of 12.7 years and a median progression‐free survival (PFS) of 8.5 years. This approach has been adopted in many centres, including in our own, for the first‐line treatment of MCL in suitable patients.Aims:The aim of this study was to retrospectively assess OS and PFS for patients undergoing ASCT for MCL over an 11‐year period in a single academic centre and to compare these real world outcomes to those reported from the Nordic MCL2 study. We also evaluated the prognostic significance of the Mantle Cell Lymphoma International Prognostic Index (MIPI) score at diagnosis.Methods:A retrospective analysis of all patients undergoing ASCT for MCL between January 2006 and October 2017 was performed. Data collected included baseline characteristics, treatment history, MIPI score at diagnosis, radiological response assessment prior to ASCT, treatment‐related morbidity and mortality, date of relapse, date of death and date of most recent follow‐up.Results:Ninety‐two patients underwent ASCT for MCL between January 2006 and October 2017. Of these, 73 were male and the median age at the time of ASCT was 58 years. All patients had a performance score of 0 or 1. A MIPI score could be calculated for 66 patients – 28 low‐risk, 24 intermediate‐risk and 14 high‐risk. Sixty‐one patients (77%) received treatment according to the Nordic MCL2 protocol. Other treatment regimens included R‐CHOP, R‐Cytarabine and R‐ESHAP and 15 patients (16%) required more than one line of treatment before proceeding to ASCT. Of 61 patients who had PET‐CT imaging before ASCT 58 (95%) had a complete metabolic response. Of 27 patients who had CT imaging before ASCT 22 (81%) had a complete response.With a median follow‐up of 5.7 years 35 patients (38%) relapsed and 32 patients (35%) died. The transplant‐related mortality rate was 4.3%. Overall, the median OS was 8.5 years and the median PFS was 5.1 years. Median OS for the low‐risk MIPI group was not reached and was superior to that for the intermediate (5.8 years, P = 0.012) and high‐risk groups (5.5 years, P = 0.0004). Median PFS for the low‐risk MIPI group (8.3 years) was superior to that for the high‐risk group (2.6 years, P = 0.001) but not significantly different to that for the intermediate group (4.5 years, P = 0.11). Outcomes for patients aged less than 60 years at the time of ASCT were superior those for older patients (median OS 9.2 versus 5.8 years, P = 0.035, median PFS 5.7 versus 4.5 years, P = 0.038). No significant difference in OS or PFS was found for any other variable.Summary/Conclusion:These real‐world data demonstrate prolonged patient survival following ASCT in MCL, although outcomes in this group appear inferior to those reported in the Nordic MCL2 trial. This may in part be due to the varied treatment regimens used in this group – 9% received R‐CHOP alone and 16% received more than 1 line of treatment prior to ASCT. In our cohort, baseline MIPI score and age (under 60 versus 60 or older) strongly predicted outcome both in terms of OS and PFS. This suggests that Nordic MCL2‐type therapy followed by ASCT may be most effective in younger patients and those with low‐risk MIPI scores, but alternative approaches should be considered for older patients and those with high‐risk scores.image