Patients with mantle cell lymphoma (MCL) who have relapsed after an autologous transplant generally have a poor prognosis. Further treatment options include a second autologous transplant, an allogeneic transplant, or various alternative treatment strategies including novel agents.
This long-term, multi-center study of 324 patients with MCL, median age of 57 years, analyzed reduced-intensity transplant outcomes in patients who were heavily pre-treated (43% of patients had >3 lines of prior therapy, including an autologous transplant in 46%).
Non-relapse mortality (NRM) was 10% at 100 days and 24% at 1 year and was significantly lower for patients receiving anti-thymocyte globulin (ATG) (RR 0.59, p=0.046). The cumulative incidence of relapse was 25% and 40% at 1 and 5 years, respectively, and was associated with chemorefractory disease (HR 0.49, p=0.01) and the use of Campath (HR 2.59, p=0.0002).
The 4-year progression-free survival rate and overall survival rate in the entire patient cohort was 31% and 40%, respectively.
The authors noted that the NRM rate was not influenced by patient age, patient performance status, donor type or exposure to previous high-dose therapy, which they said demonstrated the feasibility of using reduced-intensity HCT in this highly pre-treated patient cohort.