Stem cell transplantation for mantle cell lymphoma: should it ever be used outside clinical trials?

• Published in: Bone marrow transplantation (Basingstoke) Vol. 28; no. 9; pp. 813 - 820
• Main Author: SWEETENHAM, J. W
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.11.2001
• Subjects: Actuarial Analysis; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Autografts; Biological and medical sciences; Bone marrow; Bone Marrow Purging; Bone marrow transplantation; Bone marrow, stem cells transplantation. Graft versus host reaction; Clinical trials; Clinical Trials as Topic; Combined Modality Therapy; Disease-Free Survival; Female; Follow-Up Studies; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - mortality; Humans; Lymphoma; Lymphoma, Mantle-Cell - drug therapy; Lymphoma, Mantle-Cell - mortality; Lymphoma, Mantle-Cell - therapy; Male; Mantle cell lymphoma; Medical sciences; Middle Aged; Patients; Prognosis; Prospective Studies; Randomized Controlled Trials as Topic; Registries; Remission; Remission Induction; Salvage Therapy; Stem cell transplantation; Stem cells; Survival; Survival Analysis; Survival Rate; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation, Autologous; Transplantation, Homologous; Transplants; Treatment Outcome; Human; Stem cell; Hematopoietic cell; Homograft; Malignant hemopathy; B-Lymphocyte; Non Hodgkin lymphoma; Blood; Autograft; Lymphoproliferative syndrome; Mantle cell lymphoma; Bone marrow; Clinical trial; Graft
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1703255

The outlook for patients with mantle cell lymphoma is poor. The reported median survival in most published series is only 3 to 4 years, and even the most favorable prognostic groups have median survival rates of only 5 years, with no evidence of cure. The use of autologous and allogeneic stem cell transplantation in this disease has increased dramatically in recent years. Despite encouraging reports from single centers and registries, the impact of stem cell transplantation on the outcome for mantle cell lymphoma is unclear. Optimal first-line regimens for mantle cell lymphoma have yet to be defined, and it is therefore difficult to place the role of first remission transplantation in an appropriate context. Prospective randomized trials have been difficult to design and conduct in the absence of a well-defined 'standard' treatment. The role of stem cell transplantation as a salvage strategy is also unknown, although available data suggest that it does not improve survival in heavily pre-treated patients. In the absence of clear evidence for a survival advantage for patients receiving stem cell transplants for mantle cell lymphoma, entry into clinical trials should be a priority.