INTENSIVE THERAPY WITH PERIPHERAL STEM-CELL TRANSPLANTATION IN 16 PATIENTS WITH MANTLE CELL LYMPHOMA

Background: Despite improved detection of mantle cell lymphoma (MCL), results of its treatment with conventional therapies remain disappoint ing and the survival rate poor. The role of high-dose chemotherapy has recently been investigated but no potential benefit has been clearly established. We report here our experience with MCL patients treated w ith intensive chemotherapy and autologous stem cell transplantation (A SCT). Patients and methods: Of the 16 MCL patients who received high-d ose chemotherapy and ASCT beginning in 1989, six were treated in first -line and 10 in sensitive relapse. Twelve of 16 patients received regi mens which included total body irradiation. All patients received peri pheral blood stem cells (PBSC) with the exception of one, who underwen t bone marrow transplantation. Results: Three patients died of toxic e ffects of treatment. Three months after transplant, seven achieved com plete responses (CR) and two partial responses (PR), two were stable a nd two had progressed. With a median follow-up after transplant of 22 months, five of the six surviving patients were without progression, a nd three were in CR. The median times for event-free survival (EFS) an d overall survival (OS) were, respectively, 249 and 317 days. The expe cted three-year EFS and OS were 24%. The median survival after diagnos is was only 29 months. None of the criteria appeared to be significant ly associated with a better outcome, but first-line intensification an d a short delay after initial diagnosis may be favorable. Conclusion: In this study we were not able to confirm the hypothetical benefit of high-dose chemotherapy and PBSC transplantation in mantle cell lymphom a, even though this approach may be promising in a subgroup of patient .