Mantle cell lymphoma international prognostic index but not pretransplantation induction regimen predicts survival for patients with mantle-cell lymphoma receiving high-dose therapy and autologous stem-cell transplantation.

Abstract

PURPOSE:

High-dose therapy (HDT) and autologous stem-cell transplantation (ASCT) are frequently used in an attempt to improve outcome in patients with mantle-cell lymphoma (MCL); however, the importance of intensive induction regimens before transplantation is unknown.

PATIENTS AND METHODS:

To address this question, we evaluated baseline characteristics, time to treatment, induction regimen, disease status at the time of transplantation, and MIPI score at diagnosis and their associations with survival in 118 consecutive patients with MCL who received HDT and ASCT at our centers.

RESULTS:

The MIPI was independently associated with survival after transplantation in all 118 patients (hazard ratio [HR], 3.5; P < .001) and in the 85 patients who underwent ASCT as initial consolidation (HR, 7.2; P < .001). Overall survival rates were 93%, 60%, and 32% at 2.5 years from ASCT for all patients with low-, intermediate-, and high-risk MIPI, respectively. Low-risk MIPI scores were more common in the intensive induction group than the standard induction group in all patients (64% v 46%, respectively; P = .03) and in the initial consolidation group (66% v 45%, respectively; P = .03). After adjustment for the MIPI, an intensive induction regimen was not associated with improved survival after transplantation in all patients (HR, 0.5; P = .10), the initial consolidation group (HR, 1.1; P = .86), or patients ≤ 60 years old (HR, 0.6; P = .50). Observation of more than 3 months before initiating therapy did not yield inferior survival (HR, 2.1; P = .12) after adjustment for the MIPI in patients receiving ASCT.

CONCLUSION:

An intensive induction regimen before HDT and ASCT was not associated with improved survival after adjusting for differences in MIPI scores at diagnosis.

• Authors: Lihua E Budde, Katherine A Guthrie, Brian G Till, Oliver W Press, Thomas R Chauncey, John M Pagel, Steven H Petersdorf, William I Bensinger, Leona A Holmberg, Andrei R Shustov, Damian J Green, David G Maloney, Ajay K Gopal
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 29 Issue 22 Pg. 3023-9 (Aug 01 2011) ISSN: 1527-7755 [Electronic] United States
• PMID: 21730271 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Cytarabine

Topics

• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Cytarabine (administration & dosage)
• Female
• Hematopoietic Stem Cell Transplantation
• Humans
• Kaplan-Meier Estimate
• Lymphoma, Mantle-Cell (drug therapy, mortality, surgery, therapy)
• Male
• Middle Aged
• Patient Selection
• Predictive Value of Tests
• Remission Induction
• Risk Assessment
• Risk Factors
• Transplantation, Autologous
• Treatment Outcome