THE ROLE OF HIGH-DOSE THERAPY AND AUTOLOGOUS HEMATOPOIETIC STEM-CELL TRANSPLANTATION FOR MANTLE CELL LYMPHOMA

Background: Although-mantle cell lymphoma (MCL) is a distinct disease entity with well described clinical and pathological features, little information exists regarding its therapy. This paper will evaluate pat ients with MCL receiving either induction therapy with an anthracyclin e or high-dose chemotherapy and autologous hematopoietic stem cell tra nsplantation for relapsed disease. Patients and methods: The cases of 14 previously untreated patients with MCL who received an, anthracycli ne-containing combination chemotherapy regimen on Nebraska Lymphoma St udy Group protocols from 3/83 to 2/92 were reviewed. During the-same t ime period, a different set of nine patients with recurrent MCL were r eferred for high-dose chemoradiotherapy and autologous stem cell rescu e as salvage therapy. Results: The five year overall (OS) and failure- free (FFS) survivals from the initiation of chemotherapy for the patie nts receiving an induction therapy with an anthracycline containing re gimen were 23% and 8%, respectively. At the time of this analysis, thr ee of the nine transplant patients remain progression-free 7, 12, and 25 months post-transplant. Two year overall and FFS for all nine patie nts was 34%, Conclusions: Longer follow-up of greater patient numbers is required to determine whether high-dose therapy can overcome the ch emoresistance and increase the cure rate of MCL. Since most patients w ith this disease have minimal chance of cure with standard chemotherap y, the optimal timing for high dose therapy may be as part of front-li ne treatment. Further clinical trials are required to investigate the potential benefits of high-dose therapy for patients with MCL.