Mantle Cell Lymphoma: First-line Therapy in Patients Not Eligible for Stem Cell Transplantation

2015 ◽  
Vol 16 (6) ◽  
Author(s):  
Moniba Nazeef ◽  
Brad S. Kahl
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Mantle Cell Lymphoma ◽  
Cell Transplantation ◽  
Cell Lymphoma ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Mantle Cell

The EBMT Lymphoma Working Party-European Mantle Cell Lymphoma Network Consensus Project On The Role Of Autologous and Allogeneic Stem Cell Transplantation In Mantle Cell Lymphoma: Recommendations Applying The Delphi Procedure

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3405-3405 ◽  
Author(s):  
Stephen Paul Robinson ◽  
Paolo Corradini ◽  
Peter Dreger ◽  
Dolores Caballero ◽  
Christian H Geisler ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Mantle Cell Lymphoma ◽  
Cell Transplantation ◽  
Cell Lymphoma ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Mantle Cell

Abstract Introduction The role of both autologous (autoSCT) and allogeneic stem cell transplantation (alloSCT) in the management of patients with mantle cell lymphoma (MCL) remains to be clarified. In the absence of prospective comparative trials decision making for clinicians remains challenging. We have conducted a consensus project to provide guidance on how stem cell transplantation should be employed in MCL. Methods This was a collaborative project between the Lymphoma Working Party of the EBMT and the European Mantle Cell Lymphoma Network. The RAND modified Delphi consensus procedure was used. 12 clinicians, recognized for their expertise in MCL, from both transplant and non-transplant centres contributed. A literature search was performed and consensus statements were formulated. Panel members ranked each statement. The statements were reviewed and modified and then a second round of ranking was performed. Results Consensus agreement was reached on the following statements: 1. Patients should be considered for transplant strategies based on their biological age and comorbidities and not just chronological age. 2. An autoSCT should be considered as the standard first line consolidation therapy in all patients considered suitable for high dose therapy. 3. First line induction therapy prior to SCT should incorporate high dose cytarabine and Rituximab based regimens. 4. Patients achieving either complete remission or partial remission following induction therapy should be considered for autoSCT. 5. Patients failing to achieve a PR or CR following induction therapy should not proceed directly to an autoSCT. 6. Patients undergoing an allogeneic SCT should receive reduced intensity conditioning regimens. There was consensus disagreeing with the following statement: Prognostic criteria are available that permit the identification of low risk patients in need of first line therapy who should be considered for non-transplant based treatment. There was partial consensus agreeing with the following statements: 1. Patients relapsing after an autoSCT should be considered for an allogeneic stem cell transplant following reinduction therapy.2. Patients with evidence of MRD relapse post alloSCT should, in the absence of graft versus host disease, be considered for rapid withdrawal of immunesuppression and donor lymphocyte infusions. There was a partial consensus disagreeing with the following statements: 1 Patients should receive Rituximab maintenance following first line autologous stem cell transplant. 2. There are sufficient prognostic criteria to identify patients who should undergo an allogeneic stem cell transplantation as first line consolidation. 3. In patients relapsing after non-transplant first line therapy there are sufficient prognostic criteria to determine whether autoSCT or alloSCT consolidation should be used. Finally there was no consensus with respect to the following statements. 1. Disease response to induction therapy prior to autoSCT should be assessed by PET scan. 2. Minimal residual disease (MRD) negativity is mandatory prior to autoSCT. 3. A TBI based regimen should be considered as the standard for conditioning prior to autoSCT. 4. Patients undergoing an autoSCT should receive in-vivo purging with Rituximab at the time of high dose conditioning therapy. 5. Patients with relapsed disease following non-transplant first line therapy should be considered for an autologous stem cell transplant to consolidate second (or higher) response. 6. Patients with relapsed disease following non-transplant first line therapy should be considered for an allogeneic SCT to consolidate second (or higher) response. 7. Patients undergoing autoSCT should be monitored for MRD post transplant. 8. Patients with evidence of MRD relapse post autoSCT should receive preemptive Rituximab. 9. Patients undergoing alloSCT should be monitored for MRD post transplant. Conclusions Consensus was obtained with regard to the role of autologous SCT in first line consolidation. However, the application of appropriate clinical and molecular prognostic factors to guide therapeutic decisions and the role of allogeneic transplantation warrant further clinical investigation. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Allogeneic stem cell transplantation as part of front line therapy for Mantle cell lymphoma

2018 ◽  
Vol 184 (6) ◽  
pp. 999-1005 ◽  
Author(s):  
Simon Rule ◽  
Gordon Cook ◽  
Nigel H. Russell ◽  
Ann Hunter ◽  
Stephen Robinson ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Mantle Cell Lymphoma ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Cell Lymphoma ◽  
Front Line ◽  
Line Therapy ◽  
Mantle Cell

scholarly journals Clonal hematopoiesis evolves from pretreatment clones and stabilizes after end of chemotherapy in patients with MCL

Blood ◽  
2020 ◽  
Vol 135 (22) ◽  
pp. 2000-2004 ◽  
Author(s):  
Christian Winther Eskelund ◽  
Simon Husby ◽  
Francesco Favero ◽  
Tobias Wirenfeldt Klausen ◽  
Francisco German Rodriguez-Gonzalez ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Lymphoma ◽  
First Line ◽  
Clonal Hematopoiesis ◽  
First Line Therapy ◽  
Line Therapy ◽  
Mantle Cell ◽  
Good Risk ◽  
Line Chemotherapy

Eskelund et al examined clonal hematopoiesis (CH) in a cohort of patients with mantle cell lymphoma (MCL) treated with first-line chemotherapy and autologous stem cell transplantation. In young, good-risk MCL patients, CH after first-line therapy arises almost entirely from preexisting clones, stabilizes after a period of expansion posttransplantation, and does not negatively impact survival.

Rituximab Improves the Outcome of Upfront Autologous Stem Cell Transplantation in Mantle Cell Lymphoma: A Comparison of Different Strategies.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 5106-5106
Author(s):  
Michael Rieger ◽  
Mathias Witzens-Harig ◽  
Manfred Hensel ◽  
Baerbel Seyfarth ◽  
Maike Nickelsen ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Mantle Cell Lymphoma ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Cell Lymphoma ◽  
First Line ◽  
Rituximab Maintenance ◽  
Mantle Cell

Abstract Introduction: First-line autologous stem cell transplantation (SCT) is an accepted therapy for mantle cell lymphoma (MCL). We have recently shown that 2 standard doses of rituximab significantly improve the outcome of TBI-based upfront SCT in MCL when administered peritransplant (Haematologica 92:42; 2007). The purpose of the present retrospective analysis was to compare this approach with alternative rituximab-based strategies. Patients and treatment strategies: 34 consecutive patients treated in KI-HH received 3–6 cycles of CHOP prior to stem cell mobilization with Dexa-BEAM (n=20) or DHAP (n=14), followed by TBI-cyclophosphamide-rituximab myeloablation and SCT (CHOP/R-TBI-CY group). Patients treated in HD received 3–8 cycles of R-CHOP for cytoreduction (n=28) and mobilization (n=23; the remaining 5 patients were mobilized with R-DHAP/HAM) followed by BEAM and SCT (R-CHOP/BEAM group). 12 patients of this group received additional rituximab maintenance after SCT. Results: With a median follow-up of 38 months (9–111), estimated 4-year progression-free survival (PFS) from diagnosis of patients treated with CHOP/R-TBI-CY and R-CHOP/BEAM was 83% and 72% (log rank, p=.38), respectively. Of note, with a median follow-up of 30 months (14–57) there was no relapse in the 12 pts receiving maintenance therapy with rituximab, translating into a significantly better 4-y PFS in patients receiving R-CHOP/BEAM with rituximab maintenance vs those without (100% vs. 56%; p=.021). The PFS difference between the R-CHOP/BEAM group and the CHOP/R-TBI-CY group became borderline significant after omitting the rituximab maintenance patients (p=.055). Conclusions: In advanced-stage MCL, addition of rituximab improves disease control provided by first-line SCT. Whereas the exact dose and timing of rituximab administration remains to be settled, prospective investigation of post-transplant rituximab maintenance appears to be particularly promising.

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