The role of high-dose therapy and autologous hematopoietic stem cell transplantation for mantle cell lymphoma

Background: Although mantle cell lymphoma (MCL) is a distinctdisease entity with well described clinical and pathologicalfeatures, little information exists regarding its therapy. Thispaper will evaluate patients with MCLreceiving either inductiontherapy with an anthracycline or high-dose chemotherapy andautologous hematopoietic stem cell transplantation for relapseddisease. Patients and methods: The cases of 14 previously untreated patientswith MCL who received an anthracycline-containing combinationchemotherapy regimen on Nebraska Lymphoma Study Group protocolsfrom 3/83 to 2/92 were reviewed. During the same time period,a different set of nine patients with recurrent MCL were referredfor high-dose chemoradiotherapy and autologous stem cell rescueas salvage therapy. Results: The five year overall (OS) and failure-free (FFS) survivalsfrom the initiation of chemotherapy for the patients receivingan induction therapy with an anthracycline containing regimenwere 23% and 8%, respectively. At the time of this analysis,three of the nine transplant patients remain progression-free7, 12, and 25 months post-transplant. Two year overall and FFSfor all nine patients was 34%. Conclusions: Longer follow-up of greater patient numbers isrequired to determine whether high-dose therapy can overcomethe chemoresistance and increase the cure rate of MCL. Sincemost patients with this disease have minimal chance of curewith standard chemotherapy, the optimal timing for high dosetherapy may be as part of front-line treatment. Further clinicaltrials are required to investigate the potential benefits ofhigh-dose therapy for patients with MCL. mantle cell lymphoma, hematopoietic stem cell transplantation