Myeloablative therapy with blood stem cell transplantation is effective in mantle cell lymphoma

• Published in: Leukemia Vol. 10; no. 12; p. 1975
• Main Authors: Haas, R, Brittinger, G, Meusers, P, Murea, S, Goldschmidt, H, Wannenmacher, M, Hunstein, W
• Format: Journal Article
• Language: English
• Published: England 01.12.1996
• Subjects: Adult; Antigens, CD34 - analysis; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; B-Lymphocytes - pathology; Combined Modality Therapy; Cytarabine - administration & dosage; Dose-Response Relationship, Drug; Feasibility Studies; Female; Granulocyte Colony-Stimulating Factor - therapeutic use; Hematopoietic Stem Cell Transplantation; Humans; Lymphoma, Non-Hodgkin - radiotherapy; Lymphoma, Non-Hodgkin - surgery; Lymphoma, Non-Hodgkin - therapy; Male; Middle Aged; Mitoxantrone - administration & dosage; Transplantation Conditioning; Whole-Body Irradiation
• ISSN: 0887-6924; 1476-5551

Long-term disease-free survival following conventional cytotoxic therapy is extremely rare in patients with advanced-stage mantle cell lymphoma (MCL). High-dose conditioning therapy consisting of hyperfractionated total body irradiation (TBI, 14.4 Gy) and cyclophosphamide (200 mg/kg) was therefore offered to 13 patients (four females/nine males) with advanced-stage MCL. The patients were relatively young with a median age of 49 years (range 30-60). High-dose cytarabine and mitoxantrone with granulocyte colony-stimulating factor (G-CSF) support were given for second-line therapy and mobilization of peripheral blood stem cells (PBSC). During cytokine-stimulated marrow recovery, a median of two leukaphereses (range 1-4) were performed. Using direct immunofluorescence analysis including two-color staining, the proportion of CD19+ B cells and CD34+/CD19+ B lymphoid progenitor cells was found to be extremely low with quantities below detection limit in approximately 50% of the autografts. At the time of autografting, nine patients (pts) were in first partial (five pts) or complete (four pts) remission, while four patients had achieved a second complete remission. Following myeloablative therapy a median number of 7.5 x 10(6) CD34+ cells/kg were autografted. The median time for neutrophil (> or = 0.5 x 10(9)/l) and platelet recovery (> or = 20 x 10(9)/l) was 13 and 10 days, respectively. Hematological recovery was delayed in a patient who received 5.8 x 10(6) positively selected CD34+ cells/kg. There was one toxic death 17 days post-transplantation because of overwhelming interstitial pneumonia. Two patients with a history of previous treatment failure relapsed 10 and 11 months post-transplantation, respectively, at sites of previous disease. Ten patients are disease-free with a median follow-up time of 18 months (range 10-47). The results presented here suggest that PBSC-supported high-dose therapy including TBI may provide long-term disease-free survival for patients with advanced-stage mantle cell lymphoma.