title: Autologous or reduced-intensity conditioning allogeneic hematopoietic cell transplantation for chemotherapy-sensitive mantle-cell lymphoma: analysis of transplantation timing and modality.
abstract: OBJECTIVE
  To examine the outcomes of patients with chemotherapy-sensitive mantle-cell lymphoma (MCL) following a first hematopoietic stem-cell transplantation (HCT), comparing outcomes with autologous (auto) versus reduced-intensity conditioning allogeneic (RIC allo) HCT and with transplantation applied at different times in the disease course.
  
  
  METHODS
  In all, 519 patients who received transplantations between 1996 and 2007 and were reported to the Center for International Blood and Marrow Transplant Research were analyzed. The early transplantation cohort was defined as those patients in first partial or complete remission with no more than two lines of chemotherapy. The late transplantation cohort was defined as all the remaining patients.
  
  
  RESULTS
  Auto-HCT and RIC allo-HCT resulted in similar overall survival from transplantation for both the early (at 5 years: 61% auto-HCT v 62% RIC allo-HCT; P = .951) and late cohorts (at 5 years: 44% auto-HCT v 31% RIC allo-HCT; P = .202). In both early and late transplantation cohorts, progression/relapse was lower and nonrelapse mortality was higher in the allo-HCT group. Overall survival and progression-free survival were highest in patients who underwent auto-HCT in first complete response. Multivariate analysis of survival from diagnosis identified a survival benefit favoring early HCT for both auto-HCT and RIC allo-HCT.
  
  
  CONCLUSIONS
  For patients with chemotherapy-sensitive MCL, the optimal timing for HCT is early in the disease course. Outcomes are particularly favorable for patients undergoing auto-HCT in first complete remission. For those unable to achieve complete remission after two lines of chemotherapy or those with relapsed disease, either auto-HCT or RIC allo-HCT may be effective, although the chance for long-term remission and survival is lower.
authors.affiliation: Timothy S. Fenske and Mehdi Hamadani, Medical College of Wisconsin; Mei-Jie Zhang, Jeanette Carreras, and Parameswaran N. Hari, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Ernesto Ayala, H. Lee Moffitt Cancer Center and Research Institute, Tampa; Baldeep M. Wirk, Shands Healthcare and University of Florida, Gainesville, FL; Linda J. Burns, University of Minnesota Medical Center, Fairview, Minneapolis; David J. Inwards, Mayo Clinic Rochester, Rochester, MN; Amanda Cashen, Barnes Jewish Hospital, Washington University School of Medicine, St. Louis, MO; Luciano J. Costa, Medical University of South Carolina, Charleston, SC; César O. Freytes, South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, TX; Robert P. Gale, Imperial College; Silvia Montoto, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Leona A. Holmberg and David G. Maloney, Fred Hutchinson Cancer Research Center, Seattle, WA; Hillard M. Lazarus, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH; Richard T. Maziarz, Oregon Health and Science University, Portland, OR; Reinhold Munker, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA; Miguel-Angel Perales, Memorial Sloan-Kettering Cancer Center, New York, NY; David A. Rizzieri, Duke University Medical Center, Durham, NC; Harry C. Schouten, Academische Ziekenhuis Maastricht, Maastricht, the Netherlands; Sonali M. Smith, University of Chicago Hospitals, Chicago, IL; Edmund K. Waller, Emory University Hospital, Atlanta, GA; and Ginna G. Laport, Stanford Hospital and Clinics, Stanford, CA.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Fenske
authors.forename: Mei-Jie
authors.initials: MJ
authors.lastname: Zhang
authors.forename: Jeanette
authors.initials: J
authors.lastname: Carreras
authors.forename: Ernesto
authors.initials: E
authors.lastname: Ayala
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Burns
authors.forename: Amanda
authors.initials: A
authors.lastname: Cashen
authors.forename: Luciano J
authors.initials: LJ
authors.lastname: Costa
authors.forename: César O
authors.initials: CO
authors.lastname: Freytes
authors.forename: Robert P
authors.initials: RP
authors.lastname: Gale
authors.forename: Mehdi
authors.initials: M
authors.lastname: Hamadani
authors.forename: Leona A
authors.initials: LA
authors.lastname: Holmberg
authors.forename: David J
authors.initials: DJ
authors.lastname: Inwards
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Richard T
authors.initials: RT
authors.lastname: Maziarz
authors.forename: Reinhold
authors.initials: R
authors.lastname: Munker
authors.forename: Miguel-Angel
authors.initials: MA
authors.lastname: Perales
authors.forename: David A
authors.initials: DA
authors.lastname: Rizzieri
authors.forename: Harry C
authors.initials: HC
authors.lastname: Schouten
authors.forename: Sonali M
authors.initials: SM
authors.lastname: Smith
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Waller
authors.forename: Baldeep M
authors.initials: BM
authors.lastname: Wirk
authors.forename: Ginna G
authors.initials: GG
authors.lastname: Laport
authors.forename: David G
authors.initials: DG
authors.lastname: Maloney
authors.forename: Silvia
authors.initials: S
authors.lastname: Montoto
authors.forename: Parameswaran N
authors.initials: PN
authors.lastname: Hari
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D020522:Lymphoma, Mantle-Cell / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013997:Time Factors; D019172:Transplantation Conditioning / Q000379:methods*; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome