Pretransplantation Minimal Residual Disease Predicts Survival in Patients with Mantle Cell Lymphoma Undergoing Autologous Stem Cell Transplantation in Complete Remission.
Autologous stem cell transplantation (ASCT) is standard therapy for mantle cell lymphoma (MCL) in remission after induction chemotherapy, with the best results for patients in complete remission (CR). We hypothesized that evaluation of minimal residual disease (MRD) before ASCT could further stratify outcomes for these patients. Patients with MCL who underwent ASCT in clinical CR between 1996 and 2011 with pretransplantation MRD testing were eligible. Presence of a clonal IgH rearrangement, t(11; 14) by PCR or positive flow cytometry from blood or bone marrow, was considered positive. An adjusted proportional hazards model for associations with progression-free (PFS) and overall survival (OS) was performed. Of 75 MCL patients in CR, 8 (11%) were MRD positive. MRD positivity was associated with shorter OS and PFS. The median OS for MRD-negative patients was not reached, with 82% survival at 5 years, whereas for the MRD-positive patients, median OS was 3.01 years (hazard ratio [HR], 4.04; P = .009), with a median follow-up of 5.1 years. The median PFS for MRD-negative patients was not reached with 75% PFS at 5 years, whereas for MRD-positive patients, it was 2.38 years (HR, 3.69; P = .002). MRD positivity is independently associated with poor outcomes after ASCT for MCL patients in CR.
Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington.
Andrew J
AJ
Cowan
Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington.
Philip A
PA
Stevenson
Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington.
Ryan D
RD
Cassaday
Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington.
Solomon A
SA
Graf
Marrow Transplant Unit, Department of Laboratory Medicine, University of Washington, Seattle, Washington.
Jonathan R
JR
Fromm
Marrow Transplant Unit, Department of Laboratory Medicine, University of Washington, Seattle, Washington.
David
D
Wu
Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington.
Leona A
LA
Holmberg
Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington.
Brian G
BG
Till
Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington; VA Puget Sound Health Care System, Seattle, Washington.
Thomas R
TR
Chauncey
Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington.
Stephen D
SD
Smith
Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington.
Mary
M
Philip
Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington.
Johnnie J
JJ
Orozco
Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington.
Andrei R
AR
Shustov
Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington.
Damian J
DJ
Green
Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington.
Edward N
EN
Libby
Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington.
William I
WI
Bensinger
Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington.
Mazyar
M
Shadman
Transplantation Biology Department, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
David G
DG
Maloney
Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington.
Oliver W
OW
Press
Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington. Electronic address: agopal@u.washington.edu.
Ajay K
AK
Gopal
D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D020522:Lymphoma, Mantle-Cell / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000175:diagnosis* / Q000401:mortality; D012074:Remission Induction; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014182:Transplantation, Autologous / Q000379:methods*
Mantle cell lymphoma; Minimal residual disease; Predictors; Survival; Transplantation