Long-Term Rather than Short-Term Survival Benefit in Mantle Cell Lymphoma Patients Treated With Intensive Chemo- Immunotherapy and Hematopoietic Stem Cell Transplantation in Real World Experience

Abstract

Purpose: Mantle cell lymphoma is an aggressive B cell lymphoma with initially responded but easy to relapse and difficult to cure without survival plateau. The present recommendation of treatment includes induction chemo-immunotherapy followed by high dose chemotherapy plus autologous hematopoietic stem cell transplantation for transplant-eligible patients and chemo- immunotherapy followed by rituximab maintenance for transplant-ineligible patients. However, the best induction regimen remains to be defined and median five-year overall survival is around 60% on phase II trials of multi-center experiences. Materials & Methods: We investigated the real world outcome of our patients undergoing different regimens of induction chemo-immunotherapy and analyzed whether the intensity of treatment as one of prognostic factors upon the impact of survival. Results: Between 1997 and 2018, we analyzed 50 patients as the cohort with median age 62 (range 34 to 77), and male to female was 40 versus 10. Advanced stage of diseases were 86% (stage III 10% and stage IV 76%) of all patients. Ki-67 more than 30% of lymphomas were seen in 50% of patients and 34% with Ki-67 less than 30% and 16% were unknown. Thirty-four per cents of patients underwent intensive induction chemo-immunotherapy with or without ASCT and 66% received non- intensive treatment. Six of 31 relapsed patients had undergone allogeneic hematopoietic stem cell transplantation. Five-year overall survival was 52% with median OS 5.15 years. There was no significant survival difference between intensive versus non-intensive induction therapy with 53% versus 46% in first 5 years, however, better overall survival was seen in intensive therapy group when follow up longer. High Ki-67 patients had shorter 5-year overall survival (37% vs 63%). Transplant patients had better overall survival with 68% vs 47% in 5 years with median OS 10.86 vs 4.34 years. Conclusion: There was no statistically significant difference of survival during the initial five years but intensive induction chemo-immunotherapy with or without HDC/ASCT could achieve better survival in longer follow-up according to our real world experience.