HIGH-DOSE THERAPY WITH STEM-CELL TRANSPLANTATION FOR MANTLE CELL LYMPHOMA - RESULTS AND PROGNOSTIC FACTORS, A SINGLE-CENTER EXPERIENCE

From 1991 to 1997 18 consecutive patients with well-defined mantle cel l lymphoma (MCL) underwent high-dose therapy with unpurged autologous (17 patients) or allogeneic tone patient) stem cell transplantation. T issue sections were reviewed for morphology, immunophenotype, cyclin D 1 and P53 expression as well as proliferation index (PI). Median age o f patients was 47 years (range 40-60), Sixteen had stage TV disease,vi th bone marrow involvement in 12 and performance status was greater th an or equal to 1 in 12 patients. At the time of high-dose therapy 10 p atients were in first partial response (PR), one was in second complet e remission (CR), four were in second PR and three were refractory to conventional anthracycline-containing chemotherapy, The conditioning r egimen consisted of TBI plus chemotherapy in 13 patients and chemother apy only (BEAM) in five patients. No treatment-related deaths mere obs erved. With a median follow-up of 36 months (range 13-80) after transp lant, disease-free survival (DFS) and overall survival (OS) are estima ted to be 48 and 80% at 4 years, respectively. Significantly better re sults are achieved for patients transplanted after a TBI containing re gimen with a 4 year OS and DFS estimated at 89 and 71%, respectively c ompared to 60 and 0% respectively for patients who were conditioned wi thout TBI (P = 0.07 for OS and P < 0.0001 for DFS), There is a trend t owards better DFS when the transplant is performed in PR1 (4 year DFS: 80% with eight patients out of 10 in continuous CR 13 to 80 months, m edian 36 months after transplant) compared to more advanced stages (4 year DFS: 18% with only three patients out of eight in continuous CR 1 6, 17 and 58 months after transplant). Elastic histology and P53 overe xpression are also associated with a trend towards a worst prognosis.