Cancer Treatment Today

Mantle cell lymphoma remains difficult to treat. There is an emerging consensus that autologous stem cell transplantation cannot compensate for an inadequate front line therapy. R-CHOP-like regimens, infusion or bolus based, can lead to complete response rates of approximately 40% and overall response rates of approximately 90% and, in spite of further consolidation with ASCT, most patients will eventually relapse. Several studies are looking on alternating high dose regimens with R-CHOP, the high dose drugs being cytarabine, methotrexate or both, or, as in this case allogeneic transplantation. There is accumulating evidence that individual patients can respond for a long time to a salvage allogeneic transplantation, but also that some patients respond for a long time to salvage chemotherapy. Therefore, prospective studies are necesssary to confirm superiority of salvage allogneic transplantation for mantle cell lymphoma. Dietrich et al concludes: “The current results indicated that autoSCT was capable of inducing long-term remission up to 16 years after treatment, but the outcome of patients with MCL who relapsed after autoSCT was poor, especially if their response duration after autoSCT was short. However, for a subset of patients with relapsed MCL, alloSCT may offer the possibility of durable survival, and individual patients can enjoy long-term survival after relapse even without undergoing alloSCT.” The recommendation of Cohean et al in 2015 is similar.

Christian H. Geisler, Front-line treatment of mantle cell lymphoma, haematol August 1, 2010 vol. 95 no. 8 1241-1243

Martínez C1, Carreras E, Rovira M, Urbano-Ispizua A, Esteve J, Perales M, Fernández F, Montserrat E.Patients with mantle-cell lymphoma relapsing after autologous stem cell transplantation may be rescued by allogeneic transplantation. Bone Marrow Transplant. 2000 Sep;26(6):677-9.

David J. Inwards, Thomas E. Witzig Initial therapy of mantle cell lymphoma Therapeutic Advances in Hematology December 1, 2011 2: 381-392

Michael E. Williams Transplantation for mantle cell lymphoma: is it the right thing to do? December 6, 2013 vol. 2013 no. 1 568-574

ESMO Consensus conferences: guidelines on malignant lymphoma. part 2: marginal zone lymphoma, mantle cell lymphoma, peripheral T-cell lymphoma Ann Oncol (2013) 24 (4): 857-877

Intensive treatment strategies may not provide superior outcomes in mantle cell lymphoma: overall survival exceeding 7 years with standard therapies Ann Oncol (2008) 19 (7): 1327-1330

Sascha Dietrich et al, Patterns and Outcome of Relapse After Autologous Stem Cell Transplantation for Mantle Cell Lymphoma Cancer
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Cohen JB, Burns LJ, Bachanova V.Role of allogeneic stem cell transplantation in mantle cell lymphoma. Eur J Haematol. 2015 Apr;94(4):290-7.