The EBMT/EMCL consensus project on the role of autologous and allogeneic stem cell transplantation in mantle cell lymphoma

• Published in: Leukemia Vol. 29; no. 2; pp. 464 - 473
• Main Authors: Robinson, S, Dreger, P, Caballero, D, Corradini, P, Geisler, C, Ghielmini, M, Le Gouill, S, Kimby, E, Rule, S, Vitolo, U, Dreyling, M, Hermine, O
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 01.02.2015
• Subjects: Antibodies, Monoclonal, Murine-Derived - administration & dosage; Autografts; Care and treatment; Conditioning; Consensus Development Conferences as Topic; Consolidation; Cytarabine; Cytarabine - administration & dosage; Development and progression; Diagnosis; Europe; Hematopoietic Stem Cell Transplantation - methods; Humans; Immunotherapy; Immunotherapy - methods; Induction therapy; Irradiation; Lymphoma; Lymphoma, Mantle-Cell - immunology; Lymphoma, Mantle-Cell - therapy; Mantle; Mantle cell lymphoma; Medical treatment; Medicin och hälsovetenskap; Minimal residual disease; Monoclonal antibodies; Neoplasm, Residual; Positron emission; Positron emission tomography; Preempting; Purging; Radiation; Recurrence; Remission; Remission Induction; Rituximab; Stem cell transplantation; Stem cells; Targeted cancer therapy; Therapy; Transplantation; Transplantation Conditioning - methods; Transplantation, Autologous - methods; Transplantation, Homologous - methods; Transplants & implants; Treatment Outcome; Whole-Body Irradiation; Europe; United Kingdom
• ISSN: 0887-6924; 1476-5551; 1476-5551
• DOI: 10.1038/leu.2014.223

The role of both autologous (autoSCT) and allogeneic stem cell transplantation (alloSCT) in the management of mantle cell lymphoma (MCL) remains to be clarified. We conducted a consensus project using the RAND-modified Delphi consensus procedure to provide guidance on how SCT should be used in MCL. With regard to autoSCT, there was consensus in support of: autoSCT is the standard first-line consolidation therapy; induction therapy should include high-dose cytarabine and Rituximab; complete or partial remission should be achieved before autoSCT; Rituximab maintenance following autoSCT is not indicated; and omission of autoSCT in 'low-risk' patients is not indicated. No consensus could be reached regarding: autoSCT in the treatment of relapsed disease following non-transplant therapy; the value of positron emission tomography scanning and minimal residual disease (MRD) monitoring; in vivo purging with Rituximab; total body irradiation conditioning for autoSCT; and preemptive Rituximab after autoSCT. For alloSCT, consensus was reached in support of: alloSCT should be considered for patients relapsing after autoSCT; reduced intensity conditioning regimens should be used; allogeneic immunotherapy should be used for MRD eradication after alloSCT; and there is a lack of prognostic criteria to guide the use of alloSCT as first-line consolidation. No consensus was reached regarding the role of alloSCT for relapsed disease following non-transplant therapy.