1. Allogeneic stem cell transplantation for mantle cell lymphoma-update of the prospective trials of the East German Study Group Hematology/Oncology (OSHO#60 and #74).
- Author
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Krüger, William H., Hirt, Carsten, Basara, Nadezda, Sayer, Herbert G., Behre, Gerhard, Fischer, Thomas, Grobe, Norbert, Maschmeyer, Georg, Neumann, Thomas, Schneidewind, Laila, Niederwieser, Dietger, Dölken, Gottfried, and Schmidt, Christian A.
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MANTLE cell lymphoma , *STEM cell transplantation , *NON-Hodgkin's lymphoma , *CELL transplantation , *OVERALL survival , *LYMPHOMA treatment , *THERAPEUTIC use of antineoplastic agents , *RESEARCH , *HOMOGRAFTS , *GRAFT versus host disease , *CLINICAL trials , *DOXORUBICIN , *RESEARCH methodology , *PROGNOSIS , *IMMUNOSUPPRESSION , *MEDICAL cooperation , *EVALUATION research , *COMPARATIVE studies , *QUALITY of life , *CYCLOPHOSPHAMIDE , *PREDNISONE , *LYMPHOMAS , *VINCRISTINE , *LONGITUDINAL method - Abstract
Mantle cell lymphoma (MCL) is a non-Hodgkin's lymphoma with an often aggressive course, incurable by chemotherapy. Consolidation with high-dose therapy and autologous stem cell transplantation (autoSCT) has a low transplant-related mortality but does not lead to a survival plateau. Allogeneic stem cell transplantation (alloSCT) is associated with a higher early mortality, but can cure MCL. To investigate alloSCT for therapy of MCL, we conducted two prospective trials for de novo MCL (OSHO#74) and for relapsed or refractory MCL (OSHO#60). Fifteen and 24 patients were recruited, respectively. Induction was mainly R-DHAP alternating with R-CHOP. Conditioning was either Busulfan/Cyclophosphamide or Treosulfan/Fludarabin. Either HLA-identical siblings or matched-unrelated donors with not more than one mismatch were allowed. ATG was mandatory in mismatched or unrelated transplantation. Progression-free survival (PFS) was 62% and overall survival (OS) was 68% after 16.5-year follow-up. Significant differences in PFS and OS between both trials were not observed. Patients below 56 years and patients after myeloablative conditioning had a better outcome compared to patients of the corresponding groups. Nine patients have died between day +8 and 5.9 years after SCT. Data from 7 long-term surviving patients showed an excellent Quality-of-life (QoL) after alloSCT. AlloSCT for MCL delivers excellent long-term survival data. The early mortality is higher than after autoSCT; however, the survival curves after alloSCT indicate the curative potential of this therapy. AlloSCT is a standard of care for all feasible patients with refractory or relapsed MCL and should offer to selected patients with de novo MCL and a poor risk profile. For defining the position of alloSCT in the therapeutic algorithm of MCL therapy, a randomized comparison of autoSCT and alloSCT is mandatory. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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