Allogeneic Stem Cell Transplantation in Mantle Cell Lymphoma; Insights into Its Potential Role in the Era of New Immunotherapeutic and Targeted Therapies: The GETH/GELTAMO Experience

Allo-SCT is a curative option for selected patients with relapsed/refractory (R/R) MCL, but with significant NRM. We present the long-term results of patients receiving allo-SCT in Spain from March 1995 to February 2020. The primary endpoints were EFS, OS, and cumulative incidence (CI) of NRM, relapse, and GVHD. We included 135 patients, most (85%) receiving RIC. After a median follow-up of 68 months, 5-year EFS and OS were 47 and 50%, respectively. Overall and CR rates were 86 and 80%. The CI of relapse at 1 and 3 years were 7 and 12%. NRM at day 100 and 1 year were 17 and 32%. Previous ASCT and Grade 3–4 aGVHD were associated with a higher NRM. Grade 3–4 aGVHD, donor type (mismatch non-related), and the time-period 2006–2020 were independently related to worse EFS. Patients from 1995–2005 were younger, most from HLA-identical sibling donors, and were pretreated less. Our data confirmed that allo-SCT may be a curative option in R/R MCL with low a CI of relapse, although NRM is still high, being mainly secondary to aGVHD. The arrival of new, highly effective and low toxic immunotherapeutic or targeted therapies inevitably will relegate allo-SCT to those fit patients who fail these therapies, far away from the optimal timing of treatment.

[Sepsis due to multiple-lumen catheters in bone marrow transplantation with total parenteral nutrition. The effect of the type of isolation]

The use of catheters for total parenteral nutrition frequently leads to infectious complications which are more common and virulent in patients with marrow aplasia. The main purpose of this paper was to evaluate the influence in the development of catheter-induced sepsis of the place where it was introduced (in the theatre or hospitalization unit), the type of isolation (laminar flux unit or conventional room), and its relation to the period of isolation and of the total parenteral nutrition. Forty-one bone-marrow transplant patients were studied, 18 of them autologous and 23 allogenic, who were administered total parenteral nutrition with a two-way central venous polyurethane catheter. Of the 41 catheters applied, 16 were introduced in the operating theater and 25 in the hospitalization unit: of these, 7 and 11 respectively were infected. Isolation was as follows: 21 in standard rooms and 20 in a laminar flux unit, with 11 and 7 infections respectively. We believe that the lower level of infections in laminar flux isolation was not significant, this being a reduced number of case studies. The duration of the catheter and total parenteral nutrition for the 18 patients with sepsis was 36.5 +/- 15.1 and 23.7 +/- 8.4 days respectively: this was greater--albeit possibly not significantly so because of the special characteristics of these patients--than the 29.1 +/- 12.9 and 19.5 +/- 10.9 days for non-septic cases. This reveals a catheter sepsis rate of 43.9%, in 88% of cases caused by skin flora micro-organisms (66.6% coagulase-negative staphylococcus).(ABSTRACT TRUNCATED AT 250 WORDS)