Consolidative autologous hematopoietic stem cell transplantation after induction chemotherapy significantly improved PFS among younger patients with mantle cell lymphoma, according to a retrospective study published in Journal of Clinical Oncology.
However, propensity-score weighted analysis showed no significant OS benefit with autologous HSCT.
“Mantle cell lymphoma remains an incurable lymphoma with no clearly defined standard-of-care first-line treatment strategy,” James N. Gerson, MD, hematology-oncology fellow at Fox Chase Cancer Center and assistant professor of clinical medicine at Perelman School of Medicine at University of Pennsylvania, and colleagues wrote. “Prospective trials using intensive induction regimens ... have demonstrated improved survival compared with historical controls.”
Gerson and colleagues sought to evaluate the impact of autologous HSCT consolidation on survival among patients with mantle cell lymphoma.
The analysis included 1,029 transplant-eligible patients (median age, 57; range, 22-65; 77% men).
All patients achieved a complete response (76%) or partial response (24%) to induction chemotherapy.
The majority of patients (64%; n = 657) underwent consolidative autologous HSCT after induction.
PFS with consolidative autologous HSCT served as the primary endpoint. OS served as a secondary endpoint.
Median follow up was 76 months (range, 1-205).
Results for the entire cohort showed median PFS of 62 months and median OS of 139 months.
Unadjusted analysis showed patients who underwent autologous HSCT after induction achieved significantly longer median PFS (75 months vs. 44 months; P < .01) and OS (147 months vs. 115 months; P < .05) than those who did not undergo autologous HSCT.
Multivariable regression analysis revealed an association between autologous HSCT and improved PFS (HR = 0.54; 95% CI, 0.44-0.66), with a trend toward improved OS (HR = 0.77; 95%, 0.59-1.01).
In a propensity-score weighted analysis to limit bias, researchers again observed improved PFS (HR = 0.7; 95% CI, 0.59-0.84) with autologous HSCT; however, they saw no significant improvement in OS (HR = 0.87; 95% CI, 0.69-1.1).
About 1% of patients (n = 7) who underwent autologous HSCT died within 100 days of transplantation.
Among all patients in the study, at median follow-up of 76.8 months, 2% (n = 21) had developed secondary myelodysplastic syndrome or acute myeloid leukemia. Researchers reported no significant difference in incidence between the HSCT or no-HSCT groups (2.5% vs. 1.3%).
Study limitations included selection bias that could have informed the decision for autologous HSCT, a lack of clear data as to why patients did not undergo transplantation, a lack of standardized response assessment to induction, a lack central review of the response assessment, and no central pathology review. Certain data fields also had missing data.
“Prospective, randomized trials are urgently needed to determine the true benefit of consolidative [autologous HSCT],” Gerson and colleagues wrote. “It is likely that some subgroups derive minimal benefit from [autologous HSCT] consolidation, such as patients with certain genetic abnormalities and those who achieve minimal residual disease negativity after induction. ... With this and other well-designed prospective trials, as well as with well-validated predictive biomarkers, clinicians will be better able to provide a more refined, risk-adapted approach to the first-line management of mantle cell lymphoma.” – by John DeRosier
Disclosures: Gerson reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.