ISSN 1866-8836
Клеточная терапия и трансплантация

LY-03. Allogeneic hematopoietic stem cell transplantation in mantle cell lymphoma: RM Gorbacheva Research Institute experience

Liudmila V. Fedorova, Kirill V. Lepik, Elena V. Kondakova, Yuri R. Zalyalov, Evgenia S. Borzenkova, Nikita P. Volkov, Ivan S. Moiseev, Natalia B. Mikhailova, Alexander D. Kulagin

RM Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University, St. Petersburg, Russia

Contact: Dr. Kirill V. Lepik, e-mail: lepikkv@gmail.com

doi 10.18620/ctt-1866-8836-2020-9-3-1-152

Summary

Introduction

Despite the emergence of new drugs, a significant number of patients with relapsed and refractory (r/r) mantle cell lymphoma (MCL) cannot achieve long-term remission or cure of the disease. Therefore, the issue of optimal treatment approach for young patients with high-risk r/r MCL is extremely relevant. In this patient group, only allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains curative method of therapy. Aim of the study was to present the results of allo-HSCT in patients with r/r MCL in RM Gorbacheva Research Institute, Pavlov University.

Patients and methods

A total of 73 patients with MCL were observed. Allo-HSCT was performed in six patients. Median age was 54 (37-68). All the patients were male. CHOP-like (n=3; 50%) and high-dose cytarabine-containing regimens (n=3; 50%) were used as in 1st line therapy. Autologous HSCT was performed in two patients (33%), and three patients (50%) previously received ibrutinib. The median number of therapy lines before allo-HSCT was 3 (1 to 5). All the patients received RIC regimen before allo-HSCT: fludarabine 30 mg/m2 + bendamustine 130 mg/m2 on D-4,-3,-2 in 5 (83%) patients, and fludarabine 30 mg/m2 on D-7,-6,-5,-4,-3,-2 + busulfan 10 mg/kg in 1 patient (17%). High-dose cyclophosphamide post-transplant (PTCy) was used in all six patients. The patients received a graft from matched related (n=1), matched unrelated (n=2), partially matched unrelated (n=1), or haploidentical donor (n=2), respectively. In one case, bone marrow was the graft source, and peripheral blood stem cells, in 5 patients (83%). At the time of allo-HSCT 5 patients (83%) had complete remission (CR) and 1 patient, progressive disease (PD). One patient underwent allo-HSCT for secondary MDS, while he remained in long-term remission of MCL. This retrospective analysis assessed overall (OS) and progression-free (PFS) survival of the patients with MCL after allo-HSCT, as well as frequency and severity of acute and chronic graft-versus-host disease (GVHD).

Results

Median follow-up after allo-HSCT was 9 (4-44) months. One-year PFS was 60%. Median OS was not reached, 1-year OS was also 60%. During the follow-up examination after allo-HSCT, CR was established in all patients, including one patient who had PD before allo-HSCT. At the time of analysis, all the patients maintained CR, including 2 patients who died of severe infectious complications 7 and 10 months after allo-HSCT. Acute GVHD developed in 2 (33%) cases, including grade 3-4 aGVHD in 1 (17%) patient. Chronic GVHD was present in 3 (50%) cases, including severe cGVHD observed in 2 (33%) patients.

Conclusion

The data from a small single-center analysis indicate to promising results of allo-HSCT in patients with r/r MCL. Nevertheless, given the high risks of transplantation, careful selection of patients before allo-HSCT is necessary to reduce transplant mortality.

Keywords

Lymphoma, mantle-cell, allogeneic hematopoietic stem cell transplantation, outcomes.


Volume 9, Number 3
09/30/2020

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doi 10.18620/ctt-1866-8836-2020-9-3-1-152

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