2022 The role of EBMT hematopoietic stem cell transplantation in mantle cell lymphoma: results of a single-center exploratory study

In the era of novel drugs, the role of hematopoietic stem cell transplantation (HSCT) in mantle cell lymphoma (MCL) remains uncertain
.

Therefore, Greek investigators compared treatment strategies and survival outcomes in patients with current-stage and early-stage MCL
.

Methods: The study retrospectively enrolled adult patients with MCL who were continuously treated at Papanikolaou Hospital over the past two decades (2000-2020)
.

Patients can be divided into two treatment periods: early (2000-2011) group and late (2012-2020) group
.

Based on the treatment regimen in each period, patients in the early group were treated with RCHOP/RCEPOM as first-line therapy
.

The early group planned to use autologous HSCT as consolidation therapy, but this regimen was not feasible due to poor patient condition or mobilization
.

Therefore, in the advanced group, for patients who are suitable for transplantation, alternate intensive treatment with RCHOP/RDHAP regimen is given, and autologous HSCT is used as consolidation therapy; patients who are not suitable for transplantation first receive a combination of R-bendamustine and R-VCAP when they relapse.
ibrutinib therapy
.

In both groups, patients were scheduled to receive rituximab consolidation therapy for 2 years
.

The following variables were analyzed: pre-implantation (age, sex, MIPI, performance status, blastocysts, cytogenetics, stage, number of different lines of treatment), transplantation (donor, transplantation, preconditioning) and post-implantation (disease-free) survival [DFS], overall survival [OS]) characteristics
.

Results The study included 81 patients with MCL, 68 males and 13 females, respectively, with a median age of 59.
4 years (range: 18-82 years)
.

The median MIPI score at diagnosis was 6 (range: 1-12), and the performance status score was 1 (range: 0-4)
.

Patient characteristics and disease factors were similar in both treatment periods
.

Autologous HSCT was used more frequently in the advanced group compared with the early group due to patient status and mobilization capacity (44% vs 12%, p=0.
008)
.

The frequency of use of allogeneic HSCT was similar in both groups (7% vs 13%, p=0.
125) (Table 1)
.

Table 1 The median follow-up time for surviving patients was 40.
7 months (range: 4.
3-269.
3 months), and patients in the advanced group had significantly better DFS and OS compared with the early group (p=0.
002 and p=0.
001, Figure 1 )
.

In multivariate analysis, age and performance status were associated with DFS and OS
.

It should be noted that autologous or allogeneic HSCT treatment was not significantly associated with improved survival
.

In multivariate analysis, treatment period remained an independent predictor of DFS and OS (p=0.
034 and p=0.
032), independent of age and performance status
.

Figure 1.
Conclusions of the study.
The study showed that in the late-stage group, autologous HSCT consolidation therapy combined with novel drugs was associated with improved survival
.

The study highlights the need for further refinement of MCL treatment in the era of personalized medicine
.

References: M.
Iskas, E.
Gavriilaki, Dolgyras, et al.
HEMATOPOIETIC CELL TRANSPLANTATION IN MANTLE CELL LYMPHOMA: A LONG-TERM SINGLE CENTER EXPERIENCE.
The 48th Annual Meeting of the EBMT.
Abstract P608.
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