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Metzner B, Müller TH, Casper J, Kimmich C, Köhne CH, Petershofen E, Renzelmann A, Thole R, Voss A, Dreyling M, Hoster E, Klapper W, Pott C. Long-term outcome in patients with mantle cell lymphoma following high-dose therapy and autologous stem cell transplantation. Eur J Haematol 2023. [PMID: 37094812 DOI: 10.1111/ejh.13985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Long-term clinical and molecular remissions in patients with mantle cell lymphoma (MCL) after autologous stem cell transplantation (ASCT) have been evaluated in only a few studies. DESIGN AND METHODS Sixty-five patients with MCL received ASCT (54 first-line ASCT, 10 second-line ASCT, and 1 third-line ASCT). In the case of long-term remission (≥5 years; n = 27), peripheral blood was tested for minimal residual disease (MRD) by t(11;14)- and IGH-PCR at the last follow-up. RESULTS Ten-year overall survival (OS), progression-free survival (PFS), and freedom from progression (FFP) after first-line ASCT were 64%, 52%, and 59% versus after second-line ASCT 50%, 20%, and 20%, respectively. Five-year OS, PFS, and FFP for the first-line cohort were 79%, 63%, and 69%, respectively. Five-year OS, PFS, and FFP after second-line ASCT were 60%, 30%, and 30%, respectively. Treatment-related mortality (3 months after ASCT) was 1.5%. So far 26 patients developed sustained long-term clinical and molecular complete remissions of up to 19 years following ASCT in first treatment line. CONCLUSION Sustained long-term clinical and molecular remissions are achievable following ASCT.
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Affiliation(s)
- Bernd Metzner
- Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Oldenburg, Germany
| | - Thomas H Müller
- Red Cross Blood Transfusion Service NSTOB, Oldenburg, Germany
| | - Jochen Casper
- Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Oldenburg, Germany
| | - Christoph Kimmich
- Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Oldenburg, Germany
| | - Claus-Henning Köhne
- Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Oldenburg, Germany
| | | | - Andrea Renzelmann
- Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Oldenburg, Germany
| | - Ruth Thole
- Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Oldenburg, Germany
| | - Andreas Voss
- Department of Oncology and Hematology, Klinikum Oldenburg, University Clinic, Oldenburg, Germany
| | - Martin Dreyling
- Department of Internal Medicine III, University Hospital Munich, Grosshadern, Germany
| | - Eva Hoster
- Department of Internal Medicine III, University Hospital Munich, Grosshadern, Germany
| | - Wolfram Klapper
- Department of Pathology, Hematopathology Section and Lymph Node Registry, University of Schleswig-Holstein, Kiel, Germany
| | - Christiane Pott
- Department of Medicine II, University of Schleswig-Holstein, Kiel, Germany
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2
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Romancik JT, Chen Z, Allen PB, Waller EK, Valla K, Colbert A, Rosand C, Palmer AF, Flowers CR, Cohen JB. Ixazomib With or Without Rituximab Following Maintenance Autologous Stem Cell Transplant in Mantle Cell Lymphoma: A Single-Center Phase I Trial. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e1084-e1091. [PMID: 36180329 DOI: 10.1016/j.clml.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/12/2022] [Accepted: 08/21/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Induction chemotherapy followed by autologous stem cell transplantation (ASCT) is a standard first-line treatment for fit patients with mantle cell lymphoma (MCL). We conducted a single-center phase I trial investigating post-transplant maintenance with ixazomib, an oral proteasome inhibitor. METHODS Patients enrolled between days +70 and +180 post ASCT. Patients received ixazomib per dose cohort on days 1, 8, and 15 of each 28-day cycle for up to 10 cycles. During recruitment, published phase III data reported a survival benefit with rituximab maintenance, so all subsequent patients received ixazomib 4 mg at the same schedule along with rituximab 375 mg/m2 on day 1 of cycles 1, 3, 5, 7, and 9. All patients were in complete remission at enrollment. RESULTS Seven patients received ixazomib monotherapy; 1 dose limiting toxicity (grade 3 neutropenia) occurred at dose level 2 (4 mg). Five patients received combination Ixazomib plus rituximab, with 2 experiencing DLTs (both Grade 4 neutropenia). Grade 3-4 neutropenia, lymphopenia, and thrombocytopenia occurred in 57%, 8%, and 8% of patients, respectively. Non-hematologic adverse events (AE) included nausea (42%), peripheral neuropathy (42%), and abdominal discomfort (33%), all of which were grade 1 or 2 in severity. There were no infectious AEs. With a median follow up of 46 months, all patients are alive and in complete remission. CONCLUSION The trial was closed to further accrual due to high rates of treatment-related myelosuppression. The current dose and schedule of ixazomib, especially when combined with rituximab, results in unacceptable hematologic toxicity when administered as post-transplant maintenance in MCL. Ixazomib maintenance micro abstract: The authors conducted a phase I study investigating the use of ixazomib, an oral proteasome inhibitor, with or without rituximab in patients with mantle cell lymphoma in first remission following chemoimmunotherapy and autologous stem cell transplantation. All patients treated on study remain in complete remission with a median follow-up of 46 months, but the study was closed early due to a high rate of hematologic adverse events.
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Affiliation(s)
- Jason T Romancik
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Zhengjia Chen
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL; Biostatistics Shared Resource Core, University of Illinois Cancer Center, Chicago, IL
| | - Pamela B Allen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Edmund K Waller
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Kelly Valla
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Amanda Colbert
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Cecilia Rosand
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Alexandra F Palmer
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Christopher R Flowers
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jonathon B Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
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3
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Romancik JT, Gerber DG, Zhuang T, Cohen JB. SOHO State of the Art Updates and Next Questions: Managing Relapsed Mantle Cell Lymphoma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:557-565. [PMID: 35123927 DOI: 10.1016/j.clml.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/20/2021] [Accepted: 01/08/2022] [Indexed: 10/19/2022]
Abstract
Mantle cell lymphoma (MCL) is a rare subtype of B-cell non-Hodgkin lymphoma i.e., incurable with current therapies. While some patients experience prolonged remissions following initial therapy, most will have a relapsing-remitting course requiring several lines of treatment over the course of their disease. Several targeted therapies are now available to treat patients with relapsed MCL. The Bruton's tyrosine kinase (BTK) inhibitors, including ibrutinib, acalabrutinib, and zanubrutinib, are highly active in MCL and currently approved for treating patients with relapsed disease. Bortezomib and lenalidomide are available as monotherapy or in combination with other agents. Venetoclax is active and can be considered for use in relapsed MCL, although it is not currently approved by regulatory agencies. Chimeric antigen receptor T-cell (CAR-T) therapy with brexucabtagene autoleucel yields high response rates and is now approved for patients with relapsed MCL. Allogeneic stem cell transplant remains an option for a small subset of medically fit and motivated patients who have progressed through multiple lines of therapy, although its use is limited by substantial toxicity. There is currently no standard approach to sequencing therapies for patients with relapsed MCL, and the ability to utilize disease biologic and clinical characteristics to guide treatment decisions in this setting remains limited. In this review, we summarize the current evidence to guide the management of patients with relapsed MCL, review emerging agents and combination therapies that are under investigation, and outline our current treatment approach for these patients.
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Affiliation(s)
- Jason T Romancik
- Department of Hematology and Medical Oncology; Winship Cancer Institute at Emory University, Atlanta, GA
| | - Drew G Gerber
- Department of Hematology and Medical Oncology; Winship Cancer Institute at Emory University, Atlanta, GA
| | - Tony Zhuang
- Department of Hematology and Medical Oncology; Winship Cancer Institute at Emory University, Atlanta, GA
| | - Jonathon B Cohen
- Department of Hematology and Medical Oncology; Winship Cancer Institute at Emory University, Atlanta, GA.
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4
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Yanada M, Yamamoto K. Hematopoietic cell transplantation for mantle cell lymphoma. Int J Hematol 2022; 115:301-309. [DOI: 10.1007/s12185-022-03294-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 11/28/2022]
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5
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Roerden M, Wirths S, Sökler M, Bethge WA, Vogel W, Walz JS. Impact of Mantle Cell Lymphoma Contamination of Autologous Stem Cell Grafts on Outcome after High-Dose Chemotherapy. Cancers (Basel) 2021; 13:cancers13112558. [PMID: 34071000 PMCID: PMC8197101 DOI: 10.3390/cancers13112558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/07/2021] [Accepted: 05/18/2021] [Indexed: 11/19/2022] Open
Abstract
Simple Summary High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (Auto-HSCT) is a standard frontline treatment for fit mantle cell lymphoma (MCL) patients. As there is a need for predictive factors to identify patients unlikely to benefit from this therapy, we investigated the prognostic impact of lymphoma cell contamination of autologous stem cell grafts. Analyzing a cohort of 36 MCL patients, we show that lymphoma cell contamination of stem cell grafts is associated with poor outcomes after Auto-HSCT. Its analysis might thus improve risk assessment and enable risk-stratified treatment strategies for MCL patients. Abstract Novel predictive factors are needed to identify mantle cell lymphoma (MCL) patients at increased risk for relapse after high-dose chemotherapy and autologous hematopoietic stem cell transplantation (HDCT/Auto-HSCT). Although bone marrow and peripheral blood involvement is commonly observed in MCL and lymphoma cell contamination of autologous stem cell grafts might facilitate relapse after Auto-HSCT, prevalence and prognostic significance of residual MCL cells in autologous grafts are unknown. We therefore performed a multiparameter flow cytometry (MFC)-based measurable residual disease (MRD) assessment in autologous stem cell grafts and analyzed its association with clinical outcome in an unselected retrospective cohort of 36 MCL patients. MRD was detectable in four (11%) autologous grafts, with MRD levels ranging from 0.002% to 0.2%. Positive graft-MRD was associated with a significantly shorter progression-free and overall survival when compared to graft-MRD negative patients (median 9 vs. 56 months and 25 vs. 132 months, respectively) and predicted early relapse after Auto-HSCT (median time to relapse 9 vs. 44 months). As a predictor of outcome after HDCT/Auto-HSCT, MFC-based assessment of graft-MRD might improve risk stratification and support clinical decision making for risk-oriented treatment strategies in MCL.
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Affiliation(s)
- Malte Roerden
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, 72076 Tübingen, Germany; (S.W.); (M.S.); (W.A.B.); (W.V.); (J.S.W.)
- Institute for Cell Biology, Department of Immunology, University of Tübingen, 72076 Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies”, University of Tübingen, 72076 Tübingen, Germany
- Correspondence:
| | - Stefan Wirths
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, 72076 Tübingen, Germany; (S.W.); (M.S.); (W.A.B.); (W.V.); (J.S.W.)
| | - Martin Sökler
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, 72076 Tübingen, Germany; (S.W.); (M.S.); (W.A.B.); (W.V.); (J.S.W.)
| | - Wolfgang A. Bethge
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, 72076 Tübingen, Germany; (S.W.); (M.S.); (W.A.B.); (W.V.); (J.S.W.)
| | - Wichard Vogel
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, 72076 Tübingen, Germany; (S.W.); (M.S.); (W.A.B.); (W.V.); (J.S.W.)
| | - Juliane S. Walz
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, 72076 Tübingen, Germany; (S.W.); (M.S.); (W.A.B.); (W.V.); (J.S.W.)
- Institute for Cell Biology, Department of Immunology, University of Tübingen, 72076 Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies”, University of Tübingen, 72076 Tübingen, Germany
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology (IKP) and Robert Bosch Center for Tumor Diseases (RBCT), Auerbachstr. 112, 70376 Stuttgart, Germany
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6
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Roider T, Wang X, Hüttl K, Müller-Tidow C, Klapper W, Rosenwald A, Stewart JP, de Castro DG, Dreger P, Hermine O, Kluin-Nelemans HC, Grabe N, Dreyling M, Pott C, Ott G, Hoster E, Dietrich S. The impact of SAMHD1 expression and mutation status in mantle cell lymphoma: An analysis of the MCL Younger and Elderly trial. Int J Cancer 2020; 148:150-160. [PMID: 32638373 DOI: 10.1002/ijc.33202] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/17/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023]
Abstract
The sterile alpha motif and histidine-aspartic domain-containing protein 1 (SAMHD1) has been demonstrated to predict the response to high-dose cytarabine consolidation treatment in acute myeloid leukemia patients. Here, we evaluated SAMHD1 as potential biomarker for the response to high-dose cytarabine in mantle cell lymphoma (MCL) patients. We quantified SAMHD1 protein expression and determined the mutation status in patients of the MCL Younger and Elderly trials (n = 189), who had received high-dose cytarabine- or fludarabine-based polychemotherapy. Additionally, we quantified SAMHD1 expression in B cell lymphoma cell lines and exposed them to cytarabine, fludarabine, and clinically relevant combinations. Across both trials investigated, SAMHD1 mutations had a frequency of 7.1% (n = 13) and did not significantly affect the failure-free survival (FFS, P = .47). In patients treated with high-dose cytarabine- or fludarabine-containing regimes, SAMHD1 expression was not significantly associated with FFS or complete remission rate. SAMHD1 expression in B cell lymphoma cell lines, however, inversely correlated with their in vitro response to cytarabine as single agent (R = .65, P = .0065). This correlation could be reversed by combining cytarabine with other chemotherapeutics, such as oxaliplatin and vincristine, similar to the treatment regime of the MCL Younger trial. We conclude that this might explain why we did not observe a significant association between SAMHD1 protein expression and the outcome of MCL patients upon cytarabine-based treatment.
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Affiliation(s)
- Tobias Roider
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany.,Molecular Medicine Partnership Unit (MMPU), Heidelberg, Germany.,European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| | - Xi Wang
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany.,Molecular Medicine Partnership Unit (MMPU), Heidelberg, Germany.,European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| | - Katrin Hüttl
- Department of Clinical Pathology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Carsten Müller-Tidow
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany.,Molecular Medicine Partnership Unit (MMPU), Heidelberg, Germany.,European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| | - Wolfram Klapper
- Department of Pathology, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - James Peter Stewart
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | | | - Peter Dreger
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | | | - Hanneke C Kluin-Nelemans
- Department of Hematology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Niels Grabe
- Hamamatsu Tissue Imaging and Analysis Center (TIGA), Bioquant, University of Heidelberg, Heidelberg, Germany
| | - Martin Dreyling
- Department of Medicine III, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Christiane Pott
- Second Medical Department, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Eva Hoster
- Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Sascha Dietrich
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany.,Molecular Medicine Partnership Unit (MMPU), Heidelberg, Germany.,European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
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7
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Selberg L, Stadtherr P, Dietrich S, Tran TH, Luft T, Hegenbart U, Bondong A, Meissner J, Liebers N, Schmitt M, Ho AD, Müller-Tidow C, Dreger P. The impact of allogeneic hematopoietic cell transplantation on the mortality of poor-risk non-Hodgkin lymphoma: an intent-to-transplant analysis. Bone Marrow Transplant 2020; 56:30-37. [PMID: 32555407 DOI: 10.1038/s41409-020-0976-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/09/2020] [Indexed: 12/16/2022]
Abstract
Purpose of this single-centre retrospective study was to assess the outcome of allogeneic hematopoietic cell transplantation (alloHCT) for relapsed/refractory (r/r) non-Hodgkin lymphoma (NHL) by intent-to-transplant (ITT). Included were all consecutive patients with diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), mantle cell lymphoma (MCL), and peripheral T-cell lymphoma (PTCL) for whom a donor search was performed between 2004 and 2018. Primary endpoint was overall survival (OS) measured from search initiation. A donor search was initiated for 189 patients (DLBCL 61, FL 32, MCL 43, and PTCL 53), with 76% of the patients having active disease. OS at 5 years after search initiation for DLBCL, FL, MCL, and PTCL was 26%, 44%, 52%, and 50%, respectively. AlloHCT was performed in 137 patients (72%; DLBCL 64%). Main reason for not undergoing alloHCT was disease progression, whereas donor unavailability accounted for only 4% of pretransplantation failures. These results suggest that survival of patients with r/r NHL entering the alloHCT route may be overestimated by a factor of 1.2-1.4 if based on actually transplanted patients only. This effect should be taken into account when using alloHCT as benchmark for new therapeutic approaches for the treatment of poor-risk NHL.
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Affiliation(s)
- Lorenz Selberg
- Department Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Peter Stadtherr
- Department Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Sascha Dietrich
- Department Medicine V, University of Heidelberg, Heidelberg, Germany
| | - T Hien Tran
- Institute of Immunology, University of Heidelberg, Heidelberg, Germany
| | - Thomas Luft
- Department Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Ute Hegenbart
- Department Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Andrea Bondong
- Department Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Julia Meissner
- Department Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Nora Liebers
- Department Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Michael Schmitt
- Department Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Anthony Dick Ho
- Department Medicine V, University of Heidelberg, Heidelberg, Germany
| | | | - Peter Dreger
- Department Medicine V, University of Heidelberg, Heidelberg, Germany.
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8
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Kumar A, Sha F, Toure A, Dogan A, Ni A, Batlevi CL, Palomba MLM, Portlock C, Straus DJ, Noy A, Horwitz SM, Moskowitz A, Hamlin P, Moskowitz CH, Matasar MJ, Zelenetz AD, Younes A. Patterns of survival in patients with recurrent mantle cell lymphoma in the modern era: progressive shortening in response duration and survival after each relapse. Blood Cancer J 2019; 9:50. [PMID: 31110172 PMCID: PMC6527702 DOI: 10.1038/s41408-019-0209-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/27/2019] [Accepted: 04/03/2019] [Indexed: 01/29/2023] Open
Abstract
As the survival of patients with mantle cell lymphoma (MCL) continues to improve, patients are increasingly being treated with multiple regimens. However, outcome after each line remains poorly characterized in the modern era. To address this knowledge gap, we retrospectively studied 404 consecutive MCL patients who were managed between 2000 and 2014 at Memorial Sloan Kettering Cancer Center. Histologic diagnosis was centrally confirmed, and patients were followed longitudinally from diagnosis throughout their disease course. Progression-free survival (PFS) and overall survival (OS) were determined by Kaplan–Meier method. The median OS and PFS after first-line treatment were 9.7 and 4.0 years, respectively. After second-line therapy, the median OS and PFS were 41.1 and 14.0 months, third line were 25.2 and 6.5 months, and fourth line were 14.4 and 5.0 months. In patients less than 65 years, stem cell transplant (SCT)-based frontline regimens were associated with improved PFS compared with non-SCT regimens (median PFS: 86.2 versus 40.0 months; P < 0.01), with a trend toward longer OS (median OS: 165.0 versus 120.0 months; P = 0.06). Early treatment failure after first-line regimens was associated with worse OS (5.9 versus 2.5 years; P < 0.01). Our study should facilitate establishing proper endpoints for future clinical trials using novel treatment approaches.
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Affiliation(s)
- Anita Kumar
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Fushen Sha
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ahmed Toure
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ahmet Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andy Ni
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Connie L Batlevi
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Carol Portlock
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David J Straus
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ariela Noy
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Steven M Horwitz
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alison Moskowitz
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul Hamlin
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Craig H Moskowitz
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew J Matasar
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew D Zelenetz
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anas Younes
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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9
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Cohen JB, Zain JM, Kahl BS. Current Approaches to Mantle Cell Lymphoma: Diagnosis, Prognosis, and Therapies. Am Soc Clin Oncol Educ Book 2017; 37:512-525. [PMID: 28561694 DOI: 10.1200/edbk_175448] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Mantle cell lymphoma (MCL) is a unique lymphoma subtype, both biologically and clinically. Virtually all cases are characterized by a common genetic lesion, t(11;14), resulting in overexpression of cyclin D1. The clinical course is moderately aggressive, and the disease is considered incurable. Considerable biologic and clinical heterogeneity exists, with some patients experiencing a rapidly progressive course, while others have disease that is readily managed. New tools exist for risk stratification and may allow for a more personalized approach in the future. Landmark studies have been completed in recent years and outcomes appear to be improving. Randomized clinical trials have clarified the role of high-dose cytarabine (Ara-C) for younger patients and have demonstrated a role for maintenance rituximab therapy. Multiple areas of uncertainty remain, however, and are the focus of ongoing research. This review focuses on (1) strategies to differentiate between aggressive and less aggressive cases, (2) understanding who should receive hematopoietic stem cell transplantation, and (3) the role for maintenance therapy in MCL.
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Affiliation(s)
- Jonathon B Cohen
- From Emory University, Atlanta, GA; City of Hope, Duarte, CA; Washington University School of Medicine, St. Louis, MO
| | - Jasmine M Zain
- From Emory University, Atlanta, GA; City of Hope, Duarte, CA; Washington University School of Medicine, St. Louis, MO
| | - Brad S Kahl
- From Emory University, Atlanta, GA; City of Hope, Duarte, CA; Washington University School of Medicine, St. Louis, MO
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10
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Roider T, Dietrich S. Maintenance Rituximab after High-Dose Therapy and Autologous Stem Cell Transplantation in Mantle Cell Lymphoma. Biol Blood Marrow Transplant 2017; 23:1811-1812. [DOI: 10.1016/j.bbmt.2017.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/09/2017] [Indexed: 11/27/2022]
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11
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Riedell PA, Bishop MR. Post-autologous transplant maintenance therapies in lymphoma: current state and future directions. Bone Marrow Transplant 2017; 53:11-21. [PMID: 28967896 DOI: 10.1038/bmt.2017.196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 01/11/2023]
Abstract
Disease relapse following high-dose chemotherapy and autologous stem cell transplant (ASCT) remains the principal cause of mortality in patients with relapsed or refractory lymphomas. In an effort to prevent post-ASCT relapse, a number of studies have evaluated the role of maintenance therapy with varying success. In diffuse large B-cell lymphoma, studies evaluating maintenance rituximab (MR) following ASCT failed to demonstrate improved outcomes. In follicular lymphoma, MR was associated with an improvement in PFS; however, no overall survival (OS) benefit was noted. Emerging data evaluating MR in mantle cell lymphoma (MCL) have demonstrated improvements in PFS, although a consistent improvement in OS has yet to be demonstrated. Given the aggressive and incurable nature of MCL, it is prudent for practitioners to weigh the risks and benefits of MR in the post-ASCT setting. Similarly, post-ASCT maintenance therapy with brentuximab vedotin in Hodgkin lymphoma, has led to improved PFS and may be considered in those with a high risk of relapse. Ongoing clinical studies evaluating a multitude of novel maintenance therapies are crucial to the efforts of further defining and optimizing the role of post-transplant maintenance therapy in lymphoma.
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Affiliation(s)
- P A Riedell
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - M R Bishop
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
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Autologous hematopoietic cell transplantation of mantle cell lymphoma: emerging trends. Curr Opin Hematol 2017; 24:502-508. [PMID: 28832354 DOI: 10.1097/moh.0000000000000383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The management of mantle cell lymphoma has changed significantly with the adoption of immunochemotherapy and dose intensive treatment strategies in specific patient populations. Randomized controlled trials have established the role of rituximab-based treatments and autologous stem cell transplantation as standards of care. Novel therapeutics are also being integrated into these treatment strategies. RECENT FINDINGS Rituximab-based primary treatment has been shown to significantly improve complete remission rates. The addition of autologous stem cell transplantation has also improved progression-free survival (PFS) although data regarding potential overall survival (OS) benefits are not clear. Complete remission and minimal residual disease (MRD) negative disease states are predictive of outcome. Rituximab maintenance post SCT has also been shown to significantly improves PFS and OS. SUMMARY Current therapeutic standards in mantle cell lymphoma have clearly improved patient outcomes with improvements in remission rates, PFS, and OS. Autologous stem cell transplant (ASCT) as a consolidation strategy of primary treatment has improved outcomes, and the incorporation of novel drugs into frontline therapy may further improve the efficacy of the treatment. MRD-driven strategies may ultimately define appropriate patient subsets towards ASCT or alternative approaches.
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Epperla N, Fenske TS, Hari PN, Hamadani M. Recent advances in post autologous transplantation maintenance therapies in B-cell non-Hodgkin lymphomas. World J Transplant 2015; 5:81-88. [PMID: 26421260 PMCID: PMC4580930 DOI: 10.5500/wjt.v5.i3.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/27/2015] [Accepted: 06/19/2015] [Indexed: 02/05/2023] Open
Abstract
Lymphomas constitute the second most common indication for high dose therapy (HDT) followed by autologous hematopoietic cell transplantation (auto-HCT). The intent of administering HDT in these heterogeneous disorders varies from cure (e.g., in relapsed aggressive lymphomas) to disease control (e.g., most indolent lymphomas). Regardless of the underlying histology or remission status at transplantation, disease relapse remains the number one cause of post auto-HCT therapy failure and mortality. The last decade has seen a proliferation of clinical studies looking at prevention of post auto-HCT therapy failure with various maintenance strategies. The benefit of such therapies is in turn dependent on disease histology and timing of transplantation. In relapsed, chemosensitive diffuse large B-cell lymphoma (DLBCL), although post auto-HCT maintenance rituximab seems to be safe and feasible, it does not provide improved survival outcomes and is not recommended. The preliminary results with anti- programmed death -1 (PD-1) antibody therapy as post auto-HCT maintenance in DLBCL is promising but requires randomized validation. Similarly in follicular lymphoma, maintenance therapies including rituximab following auto-HCT should be considered investigational and offered only on a clinical trial. Rituximab maintenance results in improved progression-free survival but has not yet shown to improve overall survival in mantle cell lymphoma (MCL), but given the poor prognosis with post auto-HCT failure in MCL, maintenance rituximab can be considered on a case-by-case basis. Ongoing trials evaluating the efficacy of post auto-HCT maintenance with novel compounds (e.g., immunomodulators, PD-1 inhibitors, proteasome inhibitors and bruton’s tyrosine kinase inhibitors) will likely change the practice landscape in the near future for B cell non-Hodgkin lymphomas patients following HDT and auto-HCT.
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14
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Post-autologous transplant maintenance therapies in lymphoid malignancies: are we there yet? Bone Marrow Transplant 2015; 50:1393-404. [DOI: 10.1038/bmt.2015.184] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 06/30/2015] [Accepted: 07/06/2015] [Indexed: 12/16/2022]
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Hess G, Coiffier B, Crump M, Gisselbrecht C, Offner F, Romaguera J, Kang L, Moran PJ. Effect of prognostic classification on temsirolimus efficacy and safety in patients with relapsed or refractory mantle cell lymphoma: a retrospective analysis. Exp Hematol Oncol 2015; 4:11. [PMID: 25938001 PMCID: PMC4416347 DOI: 10.1186/s40164-015-0006-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/18/2015] [Indexed: 11/26/2022] Open
Abstract
Background Temsirolimus, a selective inhibitor of the mammalian target of rapamycin, has demonstrated clinical benefit versus investigator’s choice (INV) of therapy in patients with relapsed/refractory mantle cell lymphoma (MCL). Methods This post hoc study retrospectively assigned simplified Mantle Cell Lymphoma International Prognostic Index (MIPI) scores (ie, secondary MIPI) based on parameters at the time of randomization in patients with MCL (N = 162) who received temsirolimus 175 mg once weekly for 3 weeks followed by once-weekly 75 mg or 25 mg or the INV of active therapy. Outcomes were analyzed according to the low-, intermediate- or high-risk category. Results Patient distribution by MIPI risk category was 31%, 39%, and 30% in the low-, intermediate-, and high-risk groups, respectively. Among patients in all categories, objective response rate (complete response + partial response) was higher in patients in the temsirolimus 175/75-mg group versus the INV group, respectively: 42% versus 0% (low-risk); 33% versus 5% (intermediate-risk); 10% versus 0% (high-risk). Median progression-free survival was significantly longer with temsirolimus 175/75 mg versus INV, respectively, in patients with intermediate (4.3 vs 1.9 months; P = 0.035) or high (4.5 vs 1.6 months; P = 0.0025) risk, and a trend toward improvement was observed in patients with low risk (5.3 vs 2.6 months; P = 0.091). Improvement in median overall survival was observed with temsirolimus 175/75 mg versus INV in low-risk patients (18.0 vs 10.5 months, respectively; P = 0.069). Conclusions This analysis suggests that, compared with INV, temsirolimus demonstrated benefit in all MIPI risk categories in patients with MCL. In all treatment groups, patients with high secondary MIPI scores at baseline faced a dismal prognosis. Trial registration ClinicalTrials.gov NCT00117598. Electronic supplementary material The online version of this article (doi:10.1186/s40164-015-0006-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Georg Hess
- Department of Hematology/Oncology, Johannes Gutenberg University, Langenbeckstr. 1, Mainz, DE 55101 Germany
| | - Bertrand Coiffier
- Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Benite, France
| | | | | | | | - Jorge Romaguera
- The University of Texas MD Anderson Cancer Center, Houston, TX USA
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Sureda A, Bader P, Cesaro S, Dreger P, Duarte RF, Dufour C, Falkenburg JHF, Farge-Bancel D, Gennery A, Kröger N, Lanza F, Marsh JC, Nagler A, Peters C, Velardi A, Mohty M, Madrigal A. Indications for allo- and auto-SCT for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2015. Bone Marrow Transplant 2015; 50:1037-56. [PMID: 25798672 DOI: 10.1038/bmt.2015.6] [Citation(s) in RCA: 216] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 01/09/2015] [Indexed: 12/17/2022]
Abstract
This is the sixth special report that the European Society for Blood and Marrow Transplantation regularly publishes on the current practice and indications for haematopoietic SCT for haematological diseases, solid tumours and immune disorders in Europe. Major changes have occurred in the field of haematopoietic SCT over the last years. Cord blood units as well as haploidentical donors have been increasingly used as stem cell sources for allo-SCT, thus, augmenting the possibility of finding a suitable donor for a patient. Continuous refinement of conditioning strategies has also expanded not only the number of potential indications but also has permitted consideration of older patients or those with co-morbidity for a transplant. There is accumulating evidence of the role of haematopoietic SCT in non-haematological disorders such as autoimmune diseases. On the other hand, the advent of new drugs and very effective targeted therapy has challenged the role of SCT in some instances or at least, modified its position in the treatment armamentarium of a given patient. An updated report with revised tables and operating definitions is presented.
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Affiliation(s)
- A Sureda
- Department of Haematology, Institut Catala d'Oncologia, Hospital Duran I Reynals, Barcelona, Spain
| | - P Bader
- Universitätsklinikum Frankfurt, Goethe-Universität, Klinik für Kinder- und Jugendmedizin, Frankfurt, Germany
| | - S Cesaro
- Paediatric Haematology Oncology, Policlinico G.B. Rossi, Verona, Italy
| | - P Dreger
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - R F Duarte
- Department of Haematology, Institut Catala d'Oncologia, Hospital Duran I Reynals, Barcelona, Spain
| | - C Dufour
- Clinical And Experimental Hematology Unit. Institute G. Gaslini, Genoa, Italy
| | - J H F Falkenburg
- Department of Haematology, Leiden University Medical Center, Leiden, The Netherlands
| | - D Farge-Bancel
- Department of Haematology-BMT, Hopital St Louis, Paris, France
| | - A Gennery
- Children's BMT Unit, Great North Children's Hospital, Newcastle-Upon-Tyne, UK
| | - N Kröger
- Department of Stem Cell Transplantation, University hospital Eppendorf, Hamburg, Germany
| | - F Lanza
- Haematology and BMT Unit, Cremona, Italy
| | - J C Marsh
- Department of Haematological Medicine, King's College Hospital/King's College London, London, UK
| | - A Nagler
- Chaim Sheva Medical Center, Tel-Hashomer, Israel
| | - C Peters
- Stem Cell Transplantation Unit, St Anna Kinderspital, Vienna, Austria
| | - A Velardi
- Sezione di Ematologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Perugia, Perugia, Italy
| | - M Mohty
- Department of Haematology, H. Saint Antoine, Paris, France
| | - A Madrigal
- Anthony Nolan Research Institute, Royal Free and University College, London, UK
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Schmitt M, Trenschel R, Sayer HG, Schneider C, Glass A, Hilgendorf I, Treschl A, Junghanss C, Borchert K, Koenigsmann M, Casper J, Beelen DW, Freund M, Kahl C. Conditioning with treosulfan and fludarabine for patients with refractory or relapsed non-Hodgkin lymphoma. Mol Clin Oncol 2014; 2:773-782. [PMID: 25054045 DOI: 10.3892/mco.2014.300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 06/02/2013] [Indexed: 11/06/2022] Open
Abstract
The treatment of refractory or relapsed non-Hodgkin lymphoma (NHL) remains challenging. In this retrospective study, 88 patients with refractory or relapsed NHL received treosulfan and fludarabine as a reduced-intensity conditioning for allogeneic hematopoietic stem cell transplantation (allo-HSCT). Of the 88 intensely pre-treated patients, 73 experienced a relapse, with 18 of the 88 patients experiencing an early relapse (ER; <6 months from the last chemotherapy). At the time of allo-HSCT, 26 patients were in complete remission (CR) and 43 in partial remission (PR), 12 patients had progressive disease (PD) and 7 had stable disease (SD). A total of 47 patients received an autologous graft followed by allo-HSCT. Following allo-HSCT, 69 of the 88 patients were in CR and 7 were in PR, resulting in an overall response rate of 86.4% (76/88). A total of 33 patients achieved a CR from PR, as did 6 patients from PD and 5 from SD. Of the 88 patients, 43 (49%) were alive at the end of the follow-up period. The patients who directly underwent allo-HSCT without prior auto-HSCT exhibited a better disease-free survival (DFS; P=0.038) with a tendency (P=0.077) for a better overall survival (OS). The patients with ER exhibited a probability of OS of 0.35±0.12 after 3 and 7 years. Chronic graft-versus-host disease (cGvHD) exerted a positive effect on OS and DFS (for limited cGvHD vs. no cGvHD, P=0.002 and 0.004, respectively). In conclusion, allogeneic stem cell transplantation following conditioning with treosufan and fludarabine constitutes a viable therapeutic option for patients with refractory or relapsed NHL and should be considered early during the course of salvage treatment.
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Affiliation(s)
- Michael Schmitt
- Department of Internal Medicine III, University of Rostock, Rostock D-18057, Germany ; Department of Internal Medicine V, University of Heidelberg, Heidelberg D-69120, Germany
| | - Rudolf Trenschel
- Department of Bone Marrow Transplantation, University of Duisburg-Essen, Essen D-45147, Germany
| | - Herbert G Sayer
- Department of Hematology and Oncology, University of Jena, Jena D-07747, Germany
| | - Catarina Schneider
- Department of Internal Medicine III, University of Rostock, Rostock D-18057, Germany
| | - Aenne Glass
- Institute for Biostatistics and Informatics in Medicine and Ageing Research, University of Rostock, Rostock D-18057, Germany
| | - Inken Hilgendorf
- Department of Internal Medicine III, University of Rostock, Rostock D-18057, Germany
| | - Anne Treschl
- Department of Hematology and Oncology, University of Jena, Jena D-07747, Germany
| | - Christian Junghanss
- Department of Internal Medicine III, University of Rostock, Rostock D-18057, Germany
| | - Kersten Borchert
- Department of Internal Medicine III, University of Rostock, Rostock D-18057, Germany
| | - Michael Koenigsmann
- Department of Hematology and Oncology, University of Magdeburg, Magdeburg D-39120, Germany ; Hematology and Oncology Practice, Hannover D-30171, Germany
| | - Jochen Casper
- Department of Internal Medicine III, University of Rostock, Rostock D-18057, Germany ; Department of Oncology and Hematology, Oldenburg Hospital, Oldenburg D-26133, Germany
| | - Dietrich W Beelen
- Department of Bone Marrow Transplantation, University of Duisburg-Essen, Essen D-45147, Germany
| | - Mathias Freund
- Department of Internal Medicine III, University of Rostock, Rostock D-18057, Germany
| | - Christoph Kahl
- Department of Internal Medicine III, University of Rostock, Rostock D-18057, Germany ; Magdeburg Hospital, Magdeburg D-39130, Germany
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18
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McClune BL, Ahn KW, Wang HL, Antin JH, Artz AS, Cahn JY, Deol A, Freytes CO, Hamadani M, Holmberg LA, Jagasia MH, Jakubowski AA, Kharfan-Dabaja MA, Lazarus HM, Miller AM, Olsson R, Pedersen TL, Pidala J, Pulsipher MA, Rowe JM, Saber W, van Besien KW, Waller EK, Aljurf MD, Akpek G, Bacher U, Chao NJ, Chen YB, Cooper BW, Dehn J, de Lima MJ, Hsu JW, Lewis ID, Marks DI, McGuirk J, Cairo MS, Schouten HC, Szer J, Ramanathan M, Savani BN, Seftel M, Socie G, Vij R, Warlick ED, Weisdorf DJ. Allotransplantation for patients age ≥40 years with non-Hodgkin lymphoma: encouraging progression-free survival. Biol Blood Marrow Transplant 2014; 20:960-8. [PMID: 24641829 PMCID: PMC4057955 DOI: 10.1016/j.bbmt.2014.03.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
Abstract
Non-Hodgkin lymphoma (NHL) disproportionately affects older patients, who do not often undergo allogeneic hematopoietic cell transplantation (HCT). We analyzed Center for International Blood and Marrow Transplant Research data on 1248 patients age ≥40 years receiving reduced-intensity conditioning (RIC) or nonmyeloablative (NMA) conditioning HCT for aggressive (n = 668) or indolent (n = 580) NHL. Aggressive lymphoma was more frequent in the oldest cohort 49% for age 40 to 54 versus 57% for age 55 to 64 versus 67% for age ≥65; P = .0008). Fewer patients aged ≥65 had previous autografting (26% versus 24% versus 9%; P = .002). Rates of relapse, acute and chronic GVHD, and nonrelapse mortality (NRM) at 1 year post-HCT were similar in the 3 age cohorts (22% [95% confidence interval (CI), 19% to 26%] for age 40 to 54, 27% [95% CI, 23% to 31%] for age 55 to 64, and 34% [95% CI, 24% to 44%] for age ≥65. Progression-free survival (PFS) and overall survival (OS) at 3 years was slightly lower in the older cohorts (OS: 54% [95% CI, 50% to 58%] for age 40 to 54; 40% [95% CI, 36% to 44%] for age 55 to 64, and 39% [95% CI, 28% to 50%] for age ≥65; P < .0001). Multivariate analysis revealed no significant effect of age on the incidence of acute or chronic GVHD or relapse. Age ≥55 years, Karnofsky Performance Status <80, and HLA mismatch adversely affected NRM, PFS, and OS. Disease status at HCT, but not histological subtype, was associated with worse NRM, relapse, PFS, and OS. Even for patients age ≥55 years, OS still approached 40% at 3 years, suggesting that HCT affects long-term remission and remains underused in qualified older patients with NHL.
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Affiliation(s)
- Brian L McClune
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Kwang Woo Ahn
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Hai-Lin Wang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Joseph H Antin
- Division of Hematologic Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Andrew S Artz
- Section of Hematology/Oncology, University of Chicago School of Medicine, Chicago, Illinois
| | - Jean-Yves Cahn
- Department of Hematology, University Hospital, Grenoble, France
| | - Abhinav Deol
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - César O Freytes
- Department of Hematology, South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Madan H Jagasia
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Ann A Jakubowski
- Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Hillard M Lazarus
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH
| | - Alan M Miller
- Department of Oncology, Baylor University Medical Center, Dallas, TX
| | - Richard Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Tanya L Pedersen
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Joseph Pidala
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL
| | - Michael A Pulsipher
- Primary Children's Hospital, Division of Hematology/Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jacob M Rowe
- Department of Hematology, Rambam Medical Center, Haifa, Israel
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Edmund K Waller
- Bone Marrow and Stem Cell Transplant Center, Winship Cancer Institute, Emory University Hospital, Atlanta, Georgia
| | - Mahmoud D Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center and Research, Riyadh, Saudi Arabia
| | - Görgun Akpek
- Banner M.D. Anderson Cancer Center, Gilbert, Arizona
| | - Ulrike Bacher
- Department of Stem Cell Transplantation, University of Hamburg, Hamburg, Germany; MLL Munich Leukemia Laboratory, Munich, Germany
| | - Nelson J Chao
- Division of Cell Therapy, Duke University Medical Center, Durham, NC
| | - Yi-Bin Chen
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA
| | - Brenda W Cooper
- Division of Hematology/Oncology, University Hospitals Case Medical Center, Cleveland, OH
| | - Jason Dehn
- National Marrow Donor Program, Minneapolis, MN
| | - Marcos J de Lima
- Division of Hematology/Oncology, University Hospitals Case Medical Center, Cleveland, OH
| | - Jack W Hsu
- Division of Hematology/Oncology, Shands HealthCare, University of Florida, Gainesville, FL
| | - Ian D Lewis
- Haematology Clinical Trial Office, Royal Adelaide Hospital/SA Pathology, Adelaide, Australia
| | - David I Marks
- Avon Haematology Unit and BCH BMT Unit, Bristol Children's Hospital, Bristol, United Kingdom
| | - Joseph McGuirk
- Division of Hematology & Oncology, University of Kansas, Westwood, KS
| | - Mitchell S Cairo
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, New York Medical College, Valhalla, NY
| | - Harry C Schouten
- Division of Hematology, Academische Ziekenhuis Maastricht, Maastricht, Netherlands
| | - Jeffrey Szer
- Department of Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital City Campus, Victoria, Australia
| | - Muthalagu Ramanathan
- Department of Hematologic Malignancies Bone Marrow Transplant, UMass Memorial Medical Center, Worcester, MA
| | - Bipin N Savani
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Matthew Seftel
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Gérard Socie
- Department of Hematology, Hopital Saint Louis, Paris, France
| | - Ravi Vij
- Division of Medical Oncology, Barnes Jewish Hospital, St. Louis Children's Hospital, Washington University, St. Louis, MO
| | - Erica D Warlick
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Daniel J Weisdorf
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota.
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Dietrich S, Boumendil A, Finel H, Avivi I, Volin L, Cornelissen J, Jarosinska R, Schmid C, Finke J, Stevens W, Schouten H, Kaufmann M, Sebban C, Trneny M, Kobbe G, Fornecker L, Schetelig J, Kanfer E, Heinicke T, Pfreundschuh M, Diez-Martin J, Bordessoule D, Robinson S, Dreger P. Outcome and prognostic factors in patients with mantle-cell lymphoma relapsing after autologous stem-cell transplantation: a retrospective study of the European Group for Blood and Marrow Transplantation (EBMT). Ann Oncol 2014; 25:1053-8. [DOI: 10.1093/annonc/mdu097] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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20
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Smith MR. Is Early Hematopoietic Stem-Cell Transplantation Necessary in Mantle-Cell Lymphoma? J Clin Oncol 2014; 32:265-7. [DOI: 10.1200/jco.2013.53.2762] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Metzner B, Müller TH, Gebauer W, Casper J, Kraemer D, Rosien B, Schumann-Binarsch S, Thole R, Köhne CH, Dreyling M, Hoster E, Pott C. Long-term clinical and molecular remissions in patients with mantle cell lymphoma following high-dose therapy and autologous stem cell transplantation. Ann Hematol 2013; 93:803-10. [DOI: 10.1007/s00277-013-1976-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 11/22/2013] [Indexed: 01/01/2023]
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Rituximab maintenance therapy after autologous stem cell transplantation prolongs progression-free survival in patients with mantle cell lymphoma. Leukemia 2013; 28:708-9. [PMID: 24217198 DOI: 10.1038/leu.2013.332] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Vo P, Jaffe ES, Cook L, Ramos C, Childs R. Durable remission of mantle cell lymphoma relapsing a third time after allogeneic hematopoietic stem cell transplantation treated with rituximab, bortezomib, donor lymphocytes, and pegylated interferon. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 13:e1-5. [PMID: 23994440 DOI: 10.1016/j.clml.2013.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 05/05/2013] [Accepted: 05/07/2013] [Indexed: 12/22/2022]
Affiliation(s)
- Phuong Vo
- Department of Internal Medicine, Newark Beth Israel Medical Center, Newark, NJ..
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Zaja F, Federico M, Vitolo U, Zinzani PL. Management of relapsed/refractory mantle cell lymphoma: a review of current therapeutic strategies. Leuk Lymphoma 2013; 55:988-98. [PMID: 23865835 DOI: 10.3109/10428194.2013.825903] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Abstract Despite recent advances in therapeutic strategies, a large proportion of patients with mantle cell lymphoma (MCL) experience progression after first-line treatment. Several attempts have been made to assess the role of different therapies for the treatment of patients with relapsed/refractory mantle cell lymphoma; however, a consensus on the optimal therapeutic strategy for each individual patient has not been reached. Overall, clinical evidence from phase II studies shows that high-dose cytarabine containing regimens, stem cell transplant and different biological agents all have promising activity with acceptable safety profiles. Therefore, these therapies can represent suitable treatment options for patients with relapsed/refractory MCL. Among different biological agents, at present only temsirolimus has been tested in a phase III study. This review considers available evidence on the management of relapsed/refractory MCL as discussed during a consensus meeting on the current treatment strategies for MCL.
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Affiliation(s)
- Francesco Zaja
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari "Carlo Melzi", DISM, Azienda Ospedaliero Universitaria S. M. Misericordia , Udine , Italy
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Coiffier B. Clinical efficacy and management of temsirolimus in patients with relapsed or refractory mantle cell lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 13:351-9. [PMID: 23763923 DOI: 10.1016/j.clml.2013.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 04/10/2013] [Accepted: 04/17/2013] [Indexed: 11/30/2022]
Abstract
Most patients with mantle cell lymphoma (MCL) relapse within a few years of treatment. Conventional agents provide little benefit, thus identification of new therapies is critical to improve patient outcomes. Temsirolimus, an inhibitor of mammalian target of rapamycin, is an effective, well-tolerated option authorized in Europe for treatment of patients with relapsed/refractory MCL. Intravenous temsirolimus has been extensively studied in MCL and has consistently demonstrated single-agent antitumor activity. In the pivotal phase III trial, treatment with temsirolimus 175 mg weekly for 3 weeks followed by 75 mg weekly (175/75 mg) resulted in significant improvements in progression-free survival (P = .0009) and objective response rate (P = .002) vs. investigator's choice of therapy. Hematologic toxicities (thrombocytopenia, neutropenia) were the principal grade 3/4 adverse events associated with temsirolimus 175/75 mg. Other toxicities included increases in serum cholesterol and triglycerides, hyperglycemia, fatigue, and dyspnea. Overall, the safety profile of temsirolimus is acceptable in this setting, and most toxicities are manageable with dose modification or medical intervention. Clinical studies of temsirolimus in relapsed or refractory MCL patients aim to clarify the optimal treatment schedule and to assess rational combinations with other therapeutic agents, such as rituximab or chemotherapy. Practical considerations are discussed for the clinical use of temsirolimus in patients with MCL.
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Affiliation(s)
- Bertrand Coiffier
- Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Benite, France.
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Clinical practice guidelines for diagnosis, treatment, and follow-up of patients with mantle cell lymphoma. Recommendations from the GEL/TAMO Spanish Cooperative Group. Ann Hematol 2013; 92:1151-79. [PMID: 23716187 DOI: 10.1007/s00277-013-1783-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 05/02/2013] [Indexed: 12/22/2022]
Abstract
Mantle cell lymphoma (MCL) is considered a distinct type of B-cell lymphoma genetically characterized by the t(11;14) translocation and cyclin D1 overexpression. There is also a small subset of tumors negative for cyclin D1 expression that are morphologically and immunophenotypically indistinguishable from conventional MCL. Although in the last decades, the median overall survival of patients with MCL has improved significantly, it is still considered as one of the poorest prognoses diseases among B-cell lymphomas. Election of treatment for patients with MCL is complex due to the scarcity of solid evidence. Current available data shows that conventional chemotherapy does not yield satisfactory results as in other types of B-cell lymphomas. However, the role of other approaches such as autologous or allogenic stem cell transplantation, immunotherapy, the administration of consolidation or maintenance schedules, or the use of targeted therapies still lack clear indications. In view of this situation, the Spanish Group of Lymphomas/Autologous Bone Marrow Transplantation has conducted a series of reviews on different aspects of MCL, namely its diagnosis, prognosis, first-line and salvage treatment (both in young and elderly patients), new targeted therapies, and detection of minimal residual disease. On the basis of the available evidence, a series of recommendations have been issued with the intention of providing guidance to clinicians on the diagnosis, treatment, and monitoring of patients with MCL.
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Abstract
Mantle cell lymphoma is a well-recognized distinct clinicopathologic subtype of B-cell non-Hodgkin lymphoma. The current World Health Organization (WHO) classification subdivides this entity into aggressive and other variants. The disease has a predilection for older males, and patients typically present at an advanced stage with frequent splenomegaly and extranodal involvement including bone marrow, peripheral blood, gastrointestinal, and occasional central nervous system involvement. Early studies of therapy outcomes in this disease revealed that while response rates where high, relapse was expected after a limited period of time. Prolonged survival was uncommon, with initial median survival rates typically in the 3-4-year range. Those with a high proliferative rate, blastoid morphology, and selected clinical features were recognized as having a worse prognosis. Therapeutic approaches have diverged into aggressive therapies with high response rates and promising progression free survival rates, which may be applied to younger healthy patients, and less aggressive approaches. Aggressive therapies include intensive chemotherapy alone or chemotherapy followed by autologous stem cell transplant, which has been shown to be most effective when applied in first remission. Whether these more intense therapies result in improved survival as compared with less aggressive therapies is not well established. Allogeneic transplant has also been investigated, although high treatment-related mortality and the risk of chronic graft versus host disease and the relatively advanced age of this patient population have tempered enthusiasm for this approach. A number of less aggressive therapies have been shown to produce promising results. Consolidation and maintenance strategies are an active area of investigation. A number of newer agents have shown promising activity in relapsed disease, and are being investigated in the front-line setting. Overall survival rates are improving in this disease, with current studies suggesting a median survival of 5 or more years.
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McKay P, Leach M, Jackson R, Cook G, Rule S. Guidelines for the investigation and management of mantle cell lymphoma. Br J Haematol 2012; 159:405-26. [PMID: 22994971 DOI: 10.1111/bjh.12046] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- P McKay
- Department of Haematology, Beatson West of Scotland Cancer Centre, Gartnavel Hospital, Glasgow, UK
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Chen B, Yin G, Duan L, Li W, Jiang X. A new marker, SOX11, aids the diagnosis of mantle cell lymphoma in the prostate: A case report. Oncol Lett 2012; 4:265-267. [PMID: 22844367 DOI: 10.3892/ol.2012.732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 05/18/2012] [Indexed: 11/05/2022] Open
Abstract
Mantle cell lymphoma (MCL) of the prostate, either primary or secondary, is a rare entity. This case report examines an 83-year-old male who complained of not only nocturia (2-3 times), but also frequency and urgency of urination. The maximal urinary flow rate was 4.1 ml/sec. A transrectal ultrasound-guided prostate biopsy was advised after a hard enlargement of the prostate was detected; however, it was refused. Therefore, a plasma kinetic transurethral resection of the prostate was performed. Postoperative pathological examinations demonstrated MCL of the prostate. Positive immunohistochemistry for CD5 and cyclin D1 was observed. The diagnosis was confirmed by the introduction of a new diagnostic marker, SOX11. The maximal flow rate achieved was 15 ml/sec following surgery. To the best of our knowledge, this is the first study of MCL being diagnosed using SOX11 as a marker in the prostate. This case should alert clinicians and pathologists to pay close attention to the diagnosis of malignant lymphoma of the prostate. This study provides further insights into the diagnosis and therapy of MCL.
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Affiliation(s)
- Binghai Chen
- Department of Urology, Third Xiang-Ya Hospital of Central South University, Yuelu, Changsha 410000
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Ansell SM. Beyond targeting malignant B cells. Lancet Oncol 2012; 13:657-8. [PMID: 22677153 DOI: 10.1016/s1470-2045(12)70223-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Martin P, Smith M, Till B. Management of mantle cell lymphoma in the elderly. Best Pract Res Clin Haematol 2012; 25:221-31. [DOI: 10.1016/j.beha.2012.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Geisler CH, Kolstad A, Laurell A, Jerkeman M, Räty R, Andersen NS, Pedersen LB, Eriksson M, Nordström M, Kimby E, Bentzen H, Kuittinen O, Lauritzsen GF, Nilsson-Ehle H, Ralfkiaer E, Ehinger M, Sundström C, Delabie J, Karjalainen-Lindsberg ML, Brown P, Elonen E. Nordic MCL2 trial update: six-year follow-up after intensive immunochemotherapy for untreated mantle cell lymphoma followed by BEAM or BEAC + autologous stem-cell support: still very long survival but late relapses do occur. Br J Haematol 2012; 158:355-62. [DOI: 10.1111/j.1365-2141.2012.09174.x] [Citation(s) in RCA: 214] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 04/04/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | - Riikka Räty
- Helsinki University Central Hospital; Helsinki; Finland
| | | | | | | | | | - Eva Kimby
- Karolinska Institute; Stockholm; Sweden
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- Helsinki University Central Hospital; Helsinki; Finland
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Harel S, Delarue R, Ribrag V, Dreyling M, Hermine O. Treatment of Younger Patients With Mantle Cell Lymphoma. Semin Hematol 2011; 48:194-207. [DOI: 10.1053/j.seminhematol.2011.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Ansell SM, Tang H, Kurtin PJ, Koenig PA, Inwards DJ, Shah K, Ziesmer SC, Feldman AL, Rao R, Gupta M, Erlichman C, Witzig TE. Temsirolimus and rituximab in patients with relapsed or refractory mantle cell lymphoma: a phase 2 study. Lancet Oncol 2011; 12:361-8. [PMID: 21440503 DOI: 10.1016/s1470-2045(11)70062-6] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Temsirolimus is a mammalian target of rapamycin (mTOR) inhibitor with single-agent antitumour activity in patients with mantle cell lymphoma. We therefore tested its efficacy and toxicity in combination with rituximab (an antiCD20 antibody) in patients with relapsed or refractory mantle cell lymphoma. METHODS In a phase 2 study, patients (aged ≥18 years) at 35 centres in the USA were given temsirolimus 25 mg/week, and rituximab 375 mg/m(2) per week for 4 weeks during the first cycle and thereafter a single dose of rituximab every other 28-day cycle. Both drugs were administered intravenously. Responding patients after six cycles could continue treatment for a total of 12 cycles, and were then observed without additional maintenance treatment. The primary endpoint was the proportion of patients with either rituximab-sensitive or rituximab-refractory disease who had at least a partial response. The analyses were done on all patients who were treated. The study was registered with ClinicalTrials.gov, number NCT00109967. FINDINGS 71 patients with mantle cell lymphoma were enrolled and 69 were assessable and were included in the final analysis. The overall response rate (ORR) was 59% (41 of 69 patients)-13 (19%) patients had complete responses and 28 (41%) had partial responses. The ORR was 63% (30 of 48; 95% CI 47-76) for rituximab-sensitive patients, and 52% (11 of 21; 30-74) for rituximab-refractory patients. The most common treatment-related grade 3 or 4 adverse events in rituximab-sensitive and rituximab-refractory patients were thrombocytopenia (eight [17%] and eight [38%], respectively), neutropenia (ten [21%] and five [24%], respectively), fatigue (eight [17%] and two [10%], respectively), leucopenia (six [13%] and three [14%], respectively), pneumonia (five [10%] and two [10%], respectively), lymphopenia (five [10%] and two [10%], respectively), pneumonitis (four [8%] and none, respectively), oedema (four [8%] and none, respectively), dyspnoea (three [6%] and two [10%], respectively), and hypertriglyceridaemia (three [6%] and two [10%], respectively). INTERPRETATION mTOR inhibitors in combination with rituximab could have a role in the treatment of patients with relapsed and refractory mantle cell lymphoma. FUNDING National Institutes of Health and the Predolin Foundation.
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