SEATTLE – Can autologous stem cell transplantation extend remission of mantle cell lymphoma?

A study published in the journal Blood Research said the procedure could do that but also cautioned that the management of subsequent MCL relapse can be challenging.

VA Puget Sound Healthcare System-led researchers examined 37 consecutive patients with MCL who underwent autoSCT between 2009 and 2017 at the Seattle VAMC. The 10 patients who experienced disease progression after autoSCT were included in this analysis.

Median progression free survival after autoSCT was 1.8 years (range, 0.3–7.1) and median overall survival after progression was only 0.7 years (range, 0.1 to not reached). Researchers noted that the three who survived more than a year after progression were treated with ibrutinib.

“Our findings suggest that ibrutinib can achieve relatively prolonged control of MCL progressing after autoSCT,” the authors wrote.

MCL is an uncommon B-cell non-Hodgkin lymphoma that is typically aggressive, with an intensive, multi-phase treatment regimen generally used in patients younger than 65 and fit with advanced stage disease requiring treatment. That commonly includes induction using cytarabine-containing chemo-immunotherapy and, for those in remission, consolidation with high-dose therapy and autoSCT followed by up to three years of maintenance rituximab. That approach allows median progression-free survival (PFS) and overall survival (OS) of more than five and 10 years, respectively, according to the report.

“Nevertheless, progression after autoSCT in MCL regularly occurs and management of such cases can be a challenge within the context of extensive prior therapy,” the authors wrote. “While evidence supporting each phase of the initial therapies is established, studies that inform prognosis and management of post-autoSCT relapse of MCL are relatively few.”

Researchers pointed out that, in their experience, relapse of MCL after autoSCT is associated with an extremely poor prognosis, although some patients achieve significant benefit from additional therapy.

The study team said future research will be necessary to better define the best treatment for patients with MCL relapsed after autoSCT. “Rationally combining targeted and cytotoxic therapies promises additional progress, though where these options fit alongside therapies including salvage alloSCT and, potentially, CAR-T therapy remains to be defined,” the authors concluded. “For now, individualization of treatment recommendations after review of available treatments, toxicities, and clinical trial 1. options will continue to guide management in this challenging situation.”

  1. Wu A, Graf SA, Burwick N, et al. Mantle cell lymphoma relapsed after autologous stem cell transplantation: a single-center experience. Blood Res. 2020;55(1):57–61. doi:10.5045/br.2020.55.1.57