Autologous Hematopoietic Cell Transplant Improves Survival in Mantle Cell Lymphoma

Autologous hematopoietic cell transplantation (HCT) improves both progression-free survival (PFS) and overall survival (OS) in patients with mantle cell lymphoma (MCL), according to a new study from researchers at Cleveland Clinic and 21 other academic medical centers from around the United States and Canada.

“This was the largest outcomes analysis of MCL,” explained Brian T. Hill, MD, PhD, an oncologist at Cleveland Clinic Cancer Center. “Data from over over 900 patients with MCL were pooled and the fundamental question was posed, ‘Should autologous HCT be given in first remission in the rituximab era?’”

Standard of care for MCL, a rare subtype of non-Hodgkin lymphoma that can be aggressive, has been induction chemotherapy followed by autologous or allogenic HCT at first remission for fit patients ≤ 65. Although HCT had been used in MCL in this population, its benefit had not been quantified. The objective of this study was to assess for a PFS and OS benefit.

Retrospective analysis

The retrospective analysis examined the charts of 1113 adults newly diagnosed with MCL who were ≤ 65 years, transplant eligible at diagnosis and had received various combinations of induction chemotherapy between 2000 and 2015. Of eligible patients, 64 percent had had HCT. Although the HCT patients were slightly younger (median age 56 years) than those who had not received HCT (median age 58 years), the groups were closely matched across all other baseline characteristics.

“The outcomes were pretty clear,” explained Dr. Hill. “The patients who received consolidation HCT had superior PFS and OS.” Indeed, the study reported a median PFS of 5.2 years and an OS of 11.7 years in patients who received HCT.

“What makes these findings different,” he continued, “is that single center sites have reported similar findings, but there was always concern there was a hidden bias. But this multicenter collaboration spreads across 22 sites, each with its own practice patterns, so this is the best data set to support continued use of consolidation HCT in MCL patients.”

Benefit continues in the rituximab era

“Because outcomes of MCL were quite poor in the pre-rituximab era,” explained Dr. Hill, “HCT was thought of as a very important treatment then. With rituximab, some investigators have begun to think that these transplants may not be as essential. This study shows that even with the relatively favorable outcomes of non-HCT patients in this modern era, there can be further improvements in PFS and OS with use of consolidation HCT. And that’s good news for patients.”

Data from the study, which was led by James Gerson, MD, and Stefan Barta, MD, of the Fox Chase Cancer Center in Philadelphia, was presented at the 59th Annual Meeting and Exposition of the American Society of Hematology in early December in Atlanta, Georgia.