Stem cell transplantation for mantle cell lymphoma: should it ever be usedoutside clinical trials?

The outlook for patients with mantle cell lymphoma is poor. The reported me dian survival in most published series is only 3 to 4 years, and even the m ost favorable prognostic groups have median survival rates of only 5 years, with no evidence of cure. The use of autologous and allogeneic stem cell t ransplantation in this disease has increased dramatically in recent years. Despite encouraging reports from single centers and registries, the impact of stem cell transplantation on the outcome for mantle cell lymphoma is unc lear. Optimal first-line regimens for mantle cell lymphoma have yet to be d efined, and it is therefore difficult to place the role of first remission transplantation in an appropriate context. Prospective randomized trials ha ve been difficult to design and conduct in the absence of a well-defined 's tandard' treatment. The role of stem cell transplantation as a salvage stra tegy is also unknown, although available data suggest that it does not impr ove survival in heavily pre-treated patients. In the absence of clear evide nce for a survival advantage for patients receiving stem cell transplants f or mantle cell lymphoma, entry into clinical trials should be a priority.