Mantle Cell Lymphoma: Outcomes after Hematopoietic Stem Cell Transplantation

Background: Mantle cell lymphoma (MCL) is a B-cell Non-Hodgkin’s lymphoma (NHL) comprising 7% of adult NHL in the US with an incidence of 4-8 cases per million persons per year. Initial therapy of MCL includes a regimen with R-CHOP or Hyper-CVAD. The best data for long term survival includes cytarabine based therapy followed by autologous hematopoietic stem cell transplantation (HSCT). In the refractory/relapsed setting, allogeneic HSCT has been used successfully. Barriers to allogeneic HSCT include lack of donors and potential toxicities. Haploidentical donors broaden the donor pool. To our knowledge, there is no published data on outcomes with haploidentical HSCT in MCL.

Methods: A retrospective chart review examining outcomes in patients with MCL who underwent either autologous or allogeneic peripheral blood HSCT at Thomas Jefferson University Hospital from January 2007 to January 2013. 

Results: A total of 12 patients with MCL underwent HSCT between 2007 to 2012. Nine of 12 patients were males. Median age at transplant was 58 years (range 38 - 72). Median time from diagnosis to HSCT was 9.5 months. Five of 12 patients (4 haploidentical & 1 matched unrelated donor) underwent allogeneic HSCT and 7of 12 patients underwent autologous HSCT. In the allogeneic HSCT group, median number of prior therapies was 2. One of 5 patients had residual disease prior to HSCT. Two of 5 patients had a myeloablative regimen; 3 had reduced intensity regimen. There were no relapses or deaths in the allogeneic HSCT group. Median progression free survival (PFS) as well as median overall survival (OS) in this group was 35 months. Major complications in allogeneic HSCT were acute skin GVHD (3/5), CMV reactivation(1/5), HHV6 viremia(1/5), and acute renal failure (1/5) requiring short term dialysis. In the autologous HSCT group, the median number of prior therapies was 1. Two of 7 patients had refractory disease prior to autologous HSCT.  Post autologous HSCT 2/7 patients relapsed and 2/7 died. Major complications in this group were DVT (2/7), enterocolitis (2/7), and CHF (1/7). Median PFS and OS were 40 and 47 months respectively. Our patients who underwent autologous HSCT were transplanted earlier (08/2007 - 09/2010) than our patients who underwent allogeneic HSCT (01/2008 - 02/2012), leading to the difference in survival times.

Conclusions: 

1. Haploidentical HSCT offers a promising curative treatment for patients with MCL with expected and manageable toxicities. Although a small number of patients, this review of our data provides the background for further study of the use of haploidentical HSCT in this group of patients.
2. Autologous HSCT for patients with MCL can also provide long term disease survival.
3. Further follow up of both groups will provide better data regarding long term (>5 year) outcomes.
4. Therapy for MCL in the future is likely to include newer agents (e.g. ibrutinib) in the front line, but HSCT will remain a viable option.