Successful allogeneic stem-cell transplantation with prophylactic stepwiseG-CSF primed-DLIs for relapse after autologous transplantation in mantle cell lymphoma: A case report and literature review on the evidence of GVL effects in MCL

Mantle cell lymphoma (MCL) is a distinctive clinicopathologic entity and re presents 2-8% of all non-Hodgkin's lymphomas, The median survival of patien ts with MCL is only 3 years, and none of the available conventional chemoth erapy regimens appears curative. Encouraging results have been reported wit h high-dose chemotherapy with autologous stem-cell transplantation (autoSCT ), However, a plateau in disease-free survival was not observed in relapsed MCL on the autoSCT trials. Promisingly, alloSCT appears to induce durable remissions via a graft-versus-lymphoma (GVL) effect. Donor lymphocyte infus ions (DLIs), by Virtue of a GVL effect, have been shown to induce durable r emissions in a few cases with refractory MCL that recur after alloSCT, In t his article, we review the literature on the evidence of the GVL effects in MCL and describe a patient with relapsed MCL shortly after high-dose chemo therapy with autoSCT, The patient was then successfully treated with Bu/Cy/ VP-16 for an alloSCT followed by DLIs in a stepwise fashion. MNCs > 10 x 10 (8)/kg were collected by two large-volume leukaphereses from the donor. Har vested stem cells from the 2(nd) day were cryopreserved for the future use as prophylactic DLIs to be given in a stepwise fashion. Cyclosporin and met hotrexate were used for GVHD prophylaxis. He had achieved only a partial re sponse by D+64 post transplant. G-CSF-primed cryopreserved DLIs were then i nfused on D+64 and D+92 to enhance the GVL effect. Grade 3 intestinal GVHD developed 20 days after the 2(nd) DLI and was partially controlled with the combination of cyclosporin, prednisone, and mycophenolate mofetil. Clinica l complete remission was observed at D+112, and maintained until the last f ollowup day (D+615), Our findings suggest that alloSCT followed by prophyla ctic DLIs may offer a curative approach to refractory MCL. (C) 2000 Wiley-L iss, Inc.