Intensive therapy with peripheral stem cell transplantation in 16 patients with mantle cell lymphoma

Background: Despite improved detection of mantle cell lymphoma (MCL),results of its treatment with conventional therapies remain disappointing andthe survival rate poor. The role of high-dose chemotherapy has recently beeninvestigated but no potential benefit has been clearly established. We reporthere our experience with MCL patients treated with intensive chemotherapy andautologous stem cell transplantation (ASCT).Patients and methods: Of the 16 MCL patients who received high-dosechemotherapy and ASCT beginning in 1989, six were treated in first-line and10 in sensitive relapse. Twelve of 16 patients received regimens whichincluded total body irradiation. All patients received peripheral blood stemcells (PBSC) with the exception of one, who underwent bone marrowtransplantation.Results: Three patients died of toxic effects of treatment. Three monthsafter transplant, seven achieved complete responses (CR) and two partialresponses (PR), two were stable and two had progressed. With a medianfollow-up after transplant of 22 months, five of the six surviving patientswere without progression, and three were in CR. The median times forevent-free survival (EFS) and overall survival (OS) were, respectively, 249and 317 days. The expected three-year EFS and OS were 24%. The mediansurvival after diagnosis was only 29 months. None of the criteria appeared tobe significantly associated with a better outcome, but first-lineintensification and a short delay after initial diagnosis may be favorable.Conclusion: In this study we were not able to confirm the hypotheticalbenefit of high-dose chemotherapy and PBSC transplantation in mantle celllymphoma, even though this approach may be promising in a subgroup of patient.