title: High-dose CD20-targeted radioimmunotherapy-based autologous transplantation improves outcomes for persistent mantle cell lymphoma.
abstract: Autologous stem cell transplant (ASCT) can improve outcomes for mantle cell lymphoma (MCL) patients, yet relapses are frequent. We hypothesized that high-dose anti-CD20 radioimmunotherapy (RIT)-based conditioning could improve results in this setting. We thus assessed 162 consecutive patients with MCL at our centre undergoing ASCT following high-dose RIT-based (n = 61) or standard (n = 101) conditioning. RIT patients were less likely to be in first remission (48% vs. 72%; P = 0·002), be in complete remission (CR) (26% vs. 61%; P < 0·001) and have chemosensitive disease (84% vs. 96%; P = 0·006). RIT-based conditioning was associated with a reduced risk of treatment failure [hazard ratio (HR) 0·40; P = 0·001] and mortality (HR 0·49; P = 0·01) after adjusting for these imbalances. This difference increased as disease status worsened (from CR to partial remission to stable/progressive disease), with respective HRs of 1·14, 0·53 and 0·04 for mortality, and 0·66, 0·36 and 0·14 for treatment failure. RIT-based conditioning appears to improve outcome following ASCT for MCL patients unable to achieve CR after controlling for imbalances in important risk factors. These data support the further study of RIT and radiation-based strategies in a risk-adapted approach to ASCT for persistent MCL.
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, USA.|Division of Hematology, Department of Medicine, University of Washington, Seattle, USA.
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Cassaday
authors.affiliation: Clinical Statistics Division, Fred Hutchinson Cancer Research Center, Seattle, USA.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Stevenson
authors.affiliation: Clinical Statistics Division, Fred Hutchinson Cancer Research Center, Seattle, USA.
authors.forename: Theodore A
authors.initials: TA
authors.lastname: Gooley
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, USA.|Veterans Affairs Puget Sound Health Care System, Seattle, USA.|Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, USA.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Chauncey
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, USA.|Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Pagel
authors.affiliation: Division of Nuclear Medicine, Department of Radiology, University of Washington, Seattle, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Rajendran
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, USA.|Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, USA.
authors.forename: Brian G
authors.initials: BG
authors.lastname: Till
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, USA.|Division of Hematology, Department of Medicine, University of Washington, Seattle, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Philip
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, USA.|Division of Hematology, Department of Medicine, University of Washington, Seattle, USA.
authors.forename: Johnnie J
authors.initials: JJ
authors.lastname: Orozco
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, USA.|Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, USA.
authors.forename: William I
authors.initials: WI
authors.lastname: Bensinger
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, USA.|Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, USA.
authors.forename: Leona A
authors.initials: LA
authors.lastname: Holmberg
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, USA.|Division of Hematology, Department of Medicine, University of Washington, Seattle, USA.
authors.forename: Andrei R
authors.initials: AR
authors.lastname: Shustov
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, USA.|Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, USA.
authors.forename: Damian J
authors.initials: DJ
authors.lastname: Green
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, USA.|Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, USA.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Smith
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, USA.|Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, USA.
authors.forename: Edward N
authors.initials: EN
authors.lastname: Libby
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, USA.|Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Maloney
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, USA.|Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, USA.
authors.forename: Oliver W
authors.initials: OW
authors.lastname: Press
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, USA.|Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, USA.
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Gopal
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002908:Chronic Disease; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D020522:Lymphoma, Mantle-Cell / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy; D011446:Prospective Studies; D016499:Radioimmunotherapy / Q000379:methods*; D000069283:Rituximab / Q000008:administration & dosage*; D033581:Stem Cell Transplantation / Q000379:methods*; D019172:Transplantation Conditioning / Q000379:methods; D014182:Transplantation, Autologous / Q000379:methods
chemical_list: D000970:Antineoplastic Agents; D000069283:Rituximab
keywords: antibody therapy; non-Hodgkin lymphoma; radiotherapy; stem cell transplantation