Patterns of Transplants and Survival Outcomes for Mantle Cell Lymphoma over Last 17 Years: Single Center Experience

Introduction Mantle cell lymphoma (MCL) is aggressive disease with poor survival by chemotherapy alone. Both autologous (auto SCT) and allogeneic stem cell transplants (allo SCT) have improved outcome over years but strategies have not been clearly defined. Methods Fifty-six patients underwent transplant as consolidation therapy for MCL at Penn State Cancer Institute between Jun 2002 and Jul 2019. Three patients were excluded for being lost to follow up. We analyzed 53 patients with median follow up of 13.6 years (80-5,000 days). Results Fifty-three patient underwent either auto SCT (n=21), or allo SCT (n=32) with nonmyeloablative (NMA: n=20), reduced intensity (RIC: n=2), or myeloablative conditioning (MA: n=10). For auto SCT, median age at the time of transplant was 59.7 years (37.7-69.8 years). Disease status at transplant was complete remission 1 or 2 (CR1/2, n=16), partial remission 1 or 2 (PR1/2, n=2), and primary induction failure or relapsed refractory (PIF/Rel, n=3). Overall survival (OS) and progression free survival (PFS) were evaluated with Kaplan-Meier survival curves and log rank tests. One and 5-year OS were 74.3 and 53.7%, respectively. One and 5-year PFS were 61.9 and 42.3%, respectively. Primary causes of death were disease progression (n=1), and others (n=3). For allo SCT, median age at the time of transplant was 56.1 years (34-67.8 years). Donor types for 32 allografts included haploidentical (n=1), matched sibling (n=15), or matched unrelated donors (n=16). Disease status at transplant was CR1/2 (n=8), PR1/2 (n=4), and PIF/Rel (n=20). One and 5-year OS were 62.2 and 39.3%, and 1 and 5-year PFS were 49.5 and 28.3%, respectively. Patients who received NMA (N=20) showed a trend to have a better 1-year OS compared to those with RIC or MA (N=12; 74.4 vs 41.7%, P=0.06). Six patients developed acute graft versus host disease (GVHD: 18.8%) and 5 patients developed chronic GVHD (limited in 8 and extensive in 19%). Primary causes of death were treatment related mortality (TRM: GVHD: 4; respiratory failure: 4; multiple organ dysfunction: 1), disease progression (n=8), and others (n=2). Factors including age, sex, disease risk, status at transplant, and transplant type were used for multivariate analysis with Cox proportional hazard regression and transplant type was identified as an independent risk factors for improved OS (auto SCT: HR 0.35, 95% CI: 0.13-0.96, p Conclusion Auto SCT as well as allo SCT are consolidation therapy options for MCL. Benefit of allo SCT is offset by increased risk of TRM and GVHD. Randomized studies or larger retrospective CIBMTR data analysis may be important to answer best transplant strategy for MCL patients.