Outcome following reduced intensity allogeneic stem cell transplantation (RIC AlloSCT) for relapsed and refractory mantle-cell lymphoma (MCL): A study of the British Society for blood and marrow transplantation: a study of the British Society for Blood and Marrow Transplantation

Cook, Gordon, Smith, Graeme M, Kirkland, Keiren, Lee, Julia, Pearce, Rachel, Thomson, Kirsty, Morris, Emma, Orchard, Kim, Rule, Simon, Russell, Nigel, Craddock, Charles and Marks, David I , Clinical Trials Committee (CTC) of the British Society for Blood and Marrow Transplantation (BSBMT) (2010) Outcome following reduced intensity allogeneic stem cell transplantation (RIC AlloSCT) for relapsed and refractory mantle-cell lymphoma (MCL): A study of the British Society for blood and marrow transplantation: a study of the British Society for Blood and Marrow Transplantation. Biology of Blood and Marrow Transplantation, 16 (10), 1419-27. (doi:10.1016/j.bbmt.2010.04.006).

Abstract

Reduced intensity Allogeneic stem cell transplantation (RIC-AlloSCT) is being increasingly considered for patients with aggressive lymphoma but limited evidence exist in Mantle cell lymphoma (MCL).

Design and methods: We report a retrospective study of transplant outcomes of RIC-AlloSCT for MCL in 70 patients (median age 48 years, range 30-67), with 57 patients receiving an Alemtuzumab-containing regimen. 34% of patients had received a prior autologous stem cell transplant.

Results: The 1 & 5 year Non-relapse mortality (NRM) was 18% (95%CI 10-27) & 21% (95%CI12-31), respectively. The incidence of severe (grade III &IV) acute GVHD was 10% & the 5 year incidence of chronic GvHD was 61%. The cumulative relapse risk was 65% (95% CI 48-77) at 5 years, significantly affected by disease status at transplant (p=0.0495) specifically the presence of chemo-sensitive disease (p=0.0364). 15 of 18 relapsed patients received DLI (n=14) or a second RIC-AlloSCT (n=1) with 11 of 15 currently in CR. The 5 year OS & PFS were 37% (95% CI 25 - 56%) & 14% (95% CI 6-34%), respectively. Age at transplantation & having <2 prior lines of therapy influenced the OS where as having <2 prior lines of therapy was the only factor to influence PFS. The use of Alemtuzumab in the conditioning was associated with an improved OS at 3 years (p=0.0271).

Conclusion: RIC-AlloSCT is a potential treatment modality for aggressive MCL. For patients relapsing post-AlloSCT, the disease is salvageable with DLI. The timing of RIC-AlloSCT should be explored in prospective studies to establish the optimal role in the management of this aggressive lymphoma.

This record has no associated files available for download.

Contributors

Author: Kim Orchard

Download statistics