The Impact of Histological Subtypes on Outcome in Patients with Mantle Cell Lymphoma Treated with or without Autologous Stem Cell Transplant.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1904-1904
Author(s):  
Muhammad I. Zulfiqar ◽  
Dennis D. Weisenburger ◽  
Fausto R. Loberiza ◽  
Julie M. Vose ◽  
Philip J. Bierman ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Mantle Cell Lymphoma ◽  
Stem Cell Transplant ◽  
Cell Lymphoma ◽  
Cell Transplant ◽  
Histological Subtypes ◽  
Mantle Cell ◽  
Hodgkin's Lymphomas ◽  
The Impact

Abstract Mantle cell lymphoma (MCL) accounts for 7% of all non-Hodgkin’s lymphomas, with median overall survival in most series of 3–4 years. MCL has been classified into three histological subtypes which include diffuse MCL, nodular MCL, and blastic MCL. A relatively small number of studies have examined the prognostic importance of histology in MCL. The aim of this study was to determine if the progression free survival (PFS) and overall survival (OS) rates in mantle cell lymphoma differ among histological subtypes. A total of 102 patients with MCL, treated by the Nebraska Lymphoma Study Group between January 1986 and June 2006, with a median age of 60 years (range 32–89 years) were available for study. Patients were treated with HyperCVAD or a CHOP like regimen with or without rituximab and autologous hematopoetic stem cell transplant (ASCT). All cases were confirmed using cyclin D1 staining. Regardless of treatment, our study failed to show a significant difference in PFS (p=0.26) or OS (P=0.06) among histological subtypes. There was a trend for better survival in patients with nodular MCL. However, in patients receiving ASCT, there was a significantly higher PFS (P=0.0001) and OS (p=0.0005) compared to patients not receiving ASCT. The 3 year PFS for patients receiving HyperCVAD followed by ASCT was 64% compared to the 3 year PFS for HyperCVAD alone of 0 (p=0.008). In conclusion, we failed to show association between histological subtypes of MCL with outcomes regardless of treatment. However, the use of ASCT improved survival.

Intensive Treatment Strategies May Not Provide Superior Outcomes in Mantle Cell Lymphoma: Overall Survival Exceeding Seven Years in a Large Cohort of Patients Managed Primarily with Conservative Therapies.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1362-1362 ◽  
Author(s):  
Peter Martin ◽  
Amy Chadburn ◽  
Paul Christos ◽  
Richard R. Furman ◽  
Jia Ruan ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Mantle Cell Lymphoma ◽  
Median Overall Survival ◽  
Stem Cell Transplant ◽  
Cell Lymphoma ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
Mantle Cell ◽  
First Remission

Abstract Historically, reported outcomes in patients with mantle cell lymphoma (MCL) have been poor, with a median overall survival cited in the range of 2 to 4 years. As a consequence, recent approaches to first-line treatment have become more aggressive. Single- and oligo-center non-randomized studies with R-Hyper-CVAD and/or autologous stem cell transplant in first remission have produced 3-year overall survival >80%, prompting many to consider them as optimal standard of care. However, a substantial fraction of MCL patients are ineligible to receive these regimens due to age and comorbidities. To determine whether these interesting results might be affected by patient referral/selection biases rather than a true superiority of therapy, we evaluated outcomes from our MCL patient cohort, a group potentially shaped by similar biases but largely managed in a more conservative fashion. As progression-free survival is likely improved by aggressive treatments, our focus is on overall survival given the central importance of this endpoint. Methods: We used pathology records to identify all patients with a diagnosis of MCL evaluated at the Weill Cornell Medical Center since 1997. Patients were considered eligible for inclusion if a date of diagnosis could be identified. In the subset where clinical records were limited, an online social security database was used to verify survival. Median overall survival was calculated according to the Kaplan-Meier method. Results: We identified 181 patients with the diagnosis of MCL established by standard hematopathologic criteria. Forty-eight of these cases were outside consults to our pathology department without available clinical data. Of the remaining 133 patients, date of diagnosis was identified in 111 subjects. Median age at diagnosis was 64 years (range: 37–88). For the subset of patients with available prognostic information, 81% were stage IV, 75% had bone marrow involvement, 52% had an IPI of ≥3. The median overall survival (N=111) was 7.1 years (85 months with 95% C.I. 63 to 98 mo.). Three-year overall survival was 86% (95% C.I. 78% to 92%). Adequate information on therapy was available for 75 patients. Most patients were treated with CHOP-like regimens. Only 5 were treated with (R)-Hyper-CVAD or autologous stem cell transplant in first remission while an additional 4 patients received one of these regimens as subsequent therapy, Five patients survived longer than 10 years—one patient is alive at 15.4 years—despite never receiving Hyper-CVAD or autoSCT. Univariate analysis of treatment type revealed no significant effect on overall survival. Conclusions: Our data demonstrate that single-center outcomes with conservative approaches in MCL can yield similar overall survival to that achieved with more intensive approaches at other single-centers. Therefore patient referral/selection biases may substantially account for the perceived superiority of aggressive strategies. Intensive treatment approaches for MCL should not be considered superior with respect to overall survival in the absence of long-term data from multicenter randomized trials comparing them to more conservative strategies.

scholarly journals Outcomes in Mantle Cell Lymphoma for Elderly Patients Undergoing Autologous Stem Cell Transplant in CR1

2017 ◽  
Vol 23 (3) ◽  
pp. S265-S266
Author(s):  
Irl Brian Greenwell ◽  
Kelly Valla ◽  
Sarah Caulfield ◽  
Jeffrey M. Switchenko ◽  
Ashley Staton ◽  
...  
Keyword(s):  
Stem Cell ◽  
Elderly Patients ◽  
Mantle Cell Lymphoma ◽  
Stem Cell Transplant ◽  
Cell Lymphoma ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
Mantle Cell

Effectiveness and tolerability of first-line autologous stem cell transplant and maintenance rituximab for mantle cell lymphoma

2017 ◽  
Vol 53 (3) ◽  
pp. 347-351
Author(s):  
Umberto Falcone ◽  
Haiyan Jiang ◽  
Shaheena Bashir ◽  
Richard Tsang ◽  
Vishal Kukreti ◽  
...  
Keyword(s):  
Stem Cell ◽  
Mantle Cell Lymphoma ◽  
Stem Cell Transplant ◽  
Cell Lymphoma ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
First Line ◽  
Mantle Cell

scholarly journals T-Cell Replete Allogeneic Stem Cell Transplant Is an Effective Treatment Option for Patients with TP53 mutated Mantle Cell Lymphoma

2021 ◽  
Vol 27 (3) ◽  
pp. S421-S422
Author(s):  
Edward Robert Scheffer Cliff ◽  
Thomas Eliot Lew ◽  
Piers Blombery ◽  
Michael Dickinson ◽  
Constantine S. Tam ◽  
...  
Keyword(s):  
Stem Cell ◽  
T Cell ◽  
Mantle Cell Lymphoma ◽  
Effective Treatment ◽  
Stem Cell Transplant ◽  
Cell Lymphoma ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Effective Treatment Option ◽  
Mantle Cell

Comparison of Survival Outcomes of Patients with Mantle Cell Lymphoma (MCL) Treated with Autologous Stem Cell Transplant (ASCT) and Conventional Chemotherapy

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4491-4491
Author(s):  
Daniel C McFarland ◽  
Parameswaran Venugopal ◽  
Yan Li ◽  
Youping Deng ◽  
Stephanie A. Gregory
Keyword(s):  
Stem Cell ◽  
Treatment Group ◽  
Mantle Cell Lymphoma ◽  
Stem Cell Transplant ◽  
Cell Lymphoma ◽  
Initial Therapy ◽  
Autologous Stem Cell Transplant ◽  
Cell Transplant ◽  
Chemotherapy Group ◽  
Mantle Cell

Abstract Abstract 4491 Background: Mantle cell lymphoma is typically considered to be aggressive and incurable. About 15% of these patients have an indolent course. MCL demonstrates the aggressive features of a rapidly progressive neoplasm but with the negative consequences of an indolent lymphoma, namely incurability and frequent relapses. The median overall survival (OS) was reported at 3–4 years when MCL was first described in the 1990's. OS has since increased substantially and this is thought to be secondary to more aggressive initial therapy and improvement in supportive care. In many parts of the world, autologous stem cell transplant (ASCT) is incorporated in the front line therapy for MCL patients with good performance status. However, improvement in survival has not deemed MCL a curable disease. Concern for treatment-related morbidity seen with aggressive therapy in an incurable disease has led some centers to practice a more conservative approach. The purpose of our study was to compare patient characteristics and the overall survival of patients treated aggressively with ASCT versus conservatively with either conventional chemotherapy or no treatment at a single institution. Methods: 52 cases of confirmed mantle cell lymphoma diagnosed at Rush University Medical Center between January 2000 and November 2010 were studied. Demographic, clinical and treatment data were collected and reviewed. The Social Security Death Index and hospital records were used to assess survival. Comparative survival analysis was performed based on treatment strategies including the following: no treatment (watch and wait), chemotherapy, ASCT at any time during course of treatment. None of these patients had an allogeneic stem cell transplant. Results: 43 of the 52 cases met all inclusion criteria and had complete diagnostic and treatment data. The no-treatment group consisted of 5 cases with a median age of 59 years. The chemotherapy group included 23 cases with a median age of 68 years. The most common initial therapy was RCHOP in 14 cases, followed by various other regimens (i.e. bortezomib + rituximab, bendamustine + rituximab) in 7 cases and HyperCVAD in 2 cases. The ASCT group included 15 cases with a median age of 61 years. Pre-transplant chemotherapy was RCHOP in 4 cases, HyperCVAD in 5 cases and other regimens in 6 cases. The comparative survival analysis for the three treatment groups was not statistically significant (p=0.496) and the estimated 3 year OS was 100% for the no treatment group, 74% for the chemotherapy group and 85% for the ASCT group. The estimated 5 year OS was 100% for the no treatment group, 66% for the chemotherapy group and 68% for the ASCT group. There were no cases of allogeneic stem cell transplants. Conclusions: Our review of MCL cases treated at a single institution supports a role for conservative treatment approaches to this disease entity. This can avoid the potential long term morbidity from ASCT in a subgroup of patients while still keeping the modality of therapy as an option for them at relapse. The incidence of indolent MCL requiring no treatment was 12% which is consistent with those seen in other studies. Further research is necessary to guide treatment decisions for MCL patients whose disease characteristics are intermediate between aggressive and indolent. Disclosures: Gregory: Genentech:.

Single Dose of Pegfilgrastim (Neulasta™) Is Effective in Mobilizing CD34+ Stem Cells in Patients Undergoing Autologous Stem Cell Transplant.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5000-5000 ◽  
Author(s):  
Dustin E. Stevenson ◽  
James Splichal ◽  
David Ririe
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Mantle Cell Lymphoma ◽  
Stem Cell Transplant ◽  
Cell Lymphoma ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Al Amyloidosis ◽  
Cell Transplant ◽  
Mantle Cell

Abstract Introduction: Numerous methods of stem cell mobilization for autologous donors are utilized. These strategies include the use of chemotherapy with growth factor support or growth factors alone. All strategies involve multiple injections, lab draws, and patient discomfort and inconvenience. The addition of the PEG molecule to the N-terminus of filgrastim (G-CSF) increases its serum half-life, thereby requiring less frequent dosing. Pegfilgrastim has been found to be safe and effective for patients with chemotherapy-induced neutropenia. Pegfilgrastim in healthy donors mobilizes stem cells in a dose-dependent fashion. A previous study has shown that 12mg of pegfilgrastim given after chemomobilization with cyclophosphamide mobilized sufficient stem cells for auto-grafting. In this study, we evaluated whether a single 12mg injection of pegfilgrastim could mobilize a sufficient number of CD34+ stem cells in autologous donors who did not receive chemomobilization. Methods: Six patients intending to undergo high-dose chemotherapy with stem cell transplant were enrolled onto the study. Four of the subjects had multiple myeloma and had received prior treatment. Two of these patients had previously undergone HDC/ASCT. One patient had mantle cell lymphoma and another had AL amyloidosis. All participants received a 12mg injection of pegfilgrastim. Four days after pegfilgrastim administration, a CD34 level was checked. If this level was greater than 10 cells per uL, stem cell apheresis was initiatiated. Results: Results are presented in the table below. Five of the six participants achieved a day four CD34+ level greater that 10 cells per uL and underwent successful stem cell apheresis. The one participant that failed to mobilize had been heavily pre-treated to include a prior autologous stem cell transplant. This patient underwent a repeat stem cell transplant with cells stored from a previous collection. All of the patients with multiple myeloma or amyloidosis proceeded onto high dose chemotherapy with melphalan and autologous stem cell rescue. The patient with mantle cell lymphoma received high-dose chemotherapy with cyclophosphamide, busulfan and vincristine followed autologous stem cell rescue. The most commonly reported side effect from the pegfilgrastim was bone pain. No serious side effects were noted. Conclusions: A single, 12mg injection of pegfilgrastim is capable of mobilizing sufficient numbers of stem cells in autologous donors. This regimen is convenient to both the patient and institution. Hematologic reconstitution is similar to other stem cell mobilization regimens. Alternative mobilization strategies should be considered in patients who have been heavily pretreated. Patient # Dx: Prev Tx: Day 4CD34 Count # of Apheresis sessions # of cells collected/kg Day of neutrophil recovery post transplant Day of platelet recovery post-transplant 1 MM VAD, HDC/ASCT 6.5 N/A N/A N/A N/A 2 Mantle Cell Lymphoma HyperCVAD 36.5 1 2.94 x 10(6) 10 67 3 MM VAD 47.5 2 10.36 x 10(6) 11 11 4 MM VAD 27.5 4 7.70 x 10(6) 12 15 5 MM VAD, HDC/ASCT, Thalidomide 25.0 2 3.27 x 10(6) 11 16 6 AL Amyloidosis prednisone 29.5 4 6.28 x 10(6) 11 13

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