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Long‐term sustained disease control in patients with mantle cell lymphoma with or without active disease after treatment with allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning
Author(s) -
Vaughn Jennifer E.,
Sorror Mohamed L.,
Storer Barry E.,
Chauncey Thomas R.,
Pulsipher Michael A.,
Maziarz Richard T.,
Maris Michael B.,
Hari Parameswaran,
Laport Ginna G.,
Franke Georg N.,
Agura Edward D.,
Langston Amelia A.,
Rezvani Andrew R.,
Storb Rainer,
Sandmaier Brenda M.,
Maloney David G.
Publication year - 2015
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.29498
Subject(s) - medicine , transplantation , fludarabine , hazard ratio , mantle cell lymphoma , gastroenterology , hematopoietic stem cell transplantation , lymphoma , surgery , total body irradiation , rituximab , oncology , chemotherapy , cyclophosphamide , confidence interval
BACKGROUND Previously, early results were reported for allogeneic hematopoietic cell transplantation (HCT) after nonmyeloablative conditioning with 2 Gy of total body irradiation with or without fludarabine and/or rituximab in 33 patients with mantle cell lymphoma (MCL). METHODS This study examined the outcomes of 70 patients with MCL and included extended follow‐up (median, 10 years) for the 33 initial patients. Grafts were obtained from human leukocyte antigen (HLA)–matched, related donors (47%), unrelated donors (41%), and HLA antigen–mismatched donors (11%). RESULTS The 5‐year incidence of nonrelapse mortality was 28%. The relapse rate was 26%. The 5‐year rates of overall survival (OS) and progression‐free survival (PFS) were 55% and 46%, respectively. The 10‐year rates of OS and PFS were 44% and 41%, respectively. Eighty percent of surviving patients were off immunosuppression at the last follow‐up. The presence of relapsed or refractory disease at the time of HCT predicted a higher rate of relapse (hazard ratio [HR], 2.94; P = .05). Despite this, OS rates at 5 (51% vs 58%) and 10 years (43% vs 45%) were comparable between those with relapsed/refractory disease and those undergoing transplantation with partial or complete remission. A high‐risk cytomegalovirus (CMV) status was the only independent predictor of worse OS (HR, 2.32; P = .02). A high‐risk CMV status and a low CD3 dose predicted PFS (HR, 2.22; P = .03). CONCLUSIONS Nonmyeloablative allogeneic HCT provides a long‐term survival benefit for patients with relapsed MCL, including those with refractory disease or multiple relapses. Cancer 2015;121:3709–3716 . © 2015 American Cancer Society .