title: 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.
abstract: Reduced-intensity allogeneic stem cell transplantation (RIC-AlloSCT) is being increasingly considered for patients with aggressive lymphoma, but limited evidence exists in mantle cell lymphoma (MCL). We report a retrospective study of transplant outcomes of RIC-AlloSCT for MCL in 70 patients (median age, 48 years, range: 30-67 years), with 57 patients receiving an Alemtuzumab-containing regimen. Thirty-four percent of patients had received a prior autologous stem cell transplant. The 1- and 5-year nonrelapse mortality (NRM) was 18% (95% confidence interval [CI] 10-27) and 21% (95% CI 12-31), respectively. The incidence of severe (grade III and IV) acute graft-versus-host disease (aGVHD) was 10%, and the 5-year incidence of chronic GVHD (cGVHD) was 61%. The cumulative relapse risk was 65% (95% CI 48-77) at 5 years, significantly affected by disease status at transplant (P = .0495), specifically the presence of chemosensitive disease (P = .0364). Fifteen of 18 relapsed patients received donor lymphocyte infustion (DLI) (n = 14) or a second RIC-AlloSCT (n = 1), with 11 of 15 currently in CR. The 5-year overall survival (OS) and progression-free survival (PFS) were 37% (95% CI 25%-56%) and 14% (95% CI 6%-34%), respectively. Age at transplantation and having <2 prior lines of therapy influenced the OS, whereas 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 = .0271). 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.
authors.affiliation: St. James's Institute of Oncology, Leeds Teaching Hospitals Trust, Leeds, United Kingdom. Gordon.Cook@leedsth.nhs.uk
authors.forename: Gordon
authors.initials: G
authors.lastname: Cook
authors.forename: Graeme M
authors.initials: GM
authors.lastname: Smith
authors.forename: Keiren
authors.initials: K
authors.lastname: Kirkland
authors.forename: Julia
authors.initials: J
authors.lastname: Lee
authors.forename: Rachel
authors.initials: R
authors.lastname: Pearce
authors.forename: Kirsty
authors.initials: K
authors.lastname: Thomson
authors.forename: Emma
authors.initials: E
authors.lastname: Morris
authors.forename: Kim
authors.initials: K
authors.lastname: Orchard
authors.forename: Simon
authors.initials: S
authors.lastname: Rule
authors.forename: Nigel
authors.initials: N
authors.lastname: Russell
authors.forename: Charles
authors.initials: C
authors.lastname: Craddock
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000453:epidemiology; D018380:Hematopoietic Stem Cell Transplantation / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D047589:Leukocyte Reduction Procedures; D019520:Living Donors; D020522:Lymphoma, Mantle-Cell / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000706:statistics & numerical data; D012955:Societies, Medical; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019653:Myeloablative Agonists