title: Outcome and prognostic factors in patients with mantle-cell lymphoma relapsing after autologous stem-cell transplantation: a retrospective study of the European Group for Blood and Marrow Transplantation (EBMT).
abstract: BACKGROUND
  Autologous stem-cell transplantation (autoSCT) is considered a standard treatment of non-frail patients with mantle cell lymphoma (MCL), but little is known about outcome of MCL patients relapsing after autoSCT. We therefore sought to analyse the outcome after autoSCT failure and the efficacy of a rescue stem-cell transplantation (SCT) in this setting.
  
  
  METHODS
  Patients with MCL were eligible if they had relapsed after autoSCT performed between 2000 and 2009. A total of 1054 patients could be identified in the EBMT registry. By contacting the transplant centres, a full dataset could be retrieved for 360 patients.
  
  
  RESULTS
  Median overall survival (OS) after relapse of the whole study group was 19 months. A long (>12 months) interval between autoSCT and relapse [P < 0.001, hazard ratio (HR) 0.62], primary refractory disease (P < 0.02, HR 1.92), prior high-dose ARA-C treatment (P = 0.04, HR 1.43), and the year of relapse (P = 0.02, HR 0.92) significantly influenced OS from relapse in multivariate analysis. Eighty patients (22%) received a rescue allogeneic SCT (alloSCT). Relapse incidence, non-relapse mortality, and OS 2 years after alloSCT was 33% [confidence interval (95% CI 21% to 45%)], 30% (95% CI 19% to 42%), and 46% (95% CI 33% to 59%), respectively. Remission duration after autoSCT was the only variable significantly affecting the outcome of salvage alloSCT. In contrast, rescue autoSCT was not associated with long-term disease control. However, individual patients survived long term even without salvage transplantation.
  
  
  CONCLUSIONS
  MCL recurrence within 1 year after autoSCT has an extremely dismal outcome, while the prognosis of patients with longer remission durations after autoSCT is significantly better. AlloSCT may offer the possibility of durable survival when performed for patients with a remission duration of more than 12 months after first autoSCT, but the favourable effect of a salvage alloSCT in this setting needs further validation.
authors.affiliation: Department of Internal Medicine V, University Hospital, Heidelberg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Dietrich
authors.forename: A
authors.initials: A
authors.lastname: Boumendil
authors.forename: H
authors.initials: H
authors.lastname: Finel
authors.forename: I
authors.initials: I
authors.lastname: Avivi
authors.forename: L
authors.initials: L
authors.lastname: Volin
authors.forename: J
authors.initials: J
authors.lastname: Cornelissen
authors.forename: R J
authors.initials: RJ
authors.lastname: Jarosinska
authors.forename: C
authors.initials: C
authors.lastname: Schmid
authors.forename: J
authors.initials: J
authors.lastname: Finke
authors.forename: W B C
authors.initials: WB
authors.lastname: Stevens
authors.forename: H C
authors.initials: HC
authors.lastname: Schouten
authors.forename: M
authors.initials: M
authors.lastname: Kaufmann
authors.forename: C
authors.initials: C
authors.lastname: Sebban
authors.forename: M
authors.initials: M
authors.lastname: Trneny
authors.forename: G
authors.initials: G
authors.lastname: Kobbe
authors.forename: L M
authors.initials: LM
authors.lastname: Fornecker
authors.forename: J
authors.initials: J
authors.lastname: Schetelig
authors.forename: E
authors.initials: E
authors.lastname: Kanfer
authors.forename: T
authors.initials: T
authors.lastname: Heinicke
authors.forename: M
authors.initials: M
authors.lastname: Pfreundschuh
authors.forename: J L
authors.initials: JL
authors.lastname: Diez-Martin
authors.forename: D
authors.initials: D
authors.lastname: Bordessoule
authors.forename: S
authors.initials: S
authors.lastname: Robinson
authors.forename: P
authors.initials: P
authors.lastname: Dreger
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D020522:Lymphoma, Mantle-Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016879:Salvage Therapy; D033581:Stem Cell Transplantation; D014182:Transplantation, Autologous; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: allogeneic stem-cell transplantation; autologous stem-cell transplantation; mantle cell lymphoma relapse