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Gerson JN , Handorf E , Villa D , Gerrie AS , Chapani P , Li S , Medeiros LJ , Wang MI , Cohen JB , Calzada O , Churnetski MC , Hill BT , Sawalha Y , Hernandez-Ilizaliturri FJ , Kothari S , Vose JM , Bast MA , Fenske TS , Narayana Rao Gari S , Maddocks KJ , Bond D , Bachanova V , Kolla B , Chavez J , Shah B , Lansigan F , Burns TF , Donovan AM , Wagner-Johnston N , Messmer M , Mehta A , Anderson JK , Reddy N , Kovach AE , Landsburg DJ , Glenn M , Inwards DJ , Karmali R , Kaplan JB , Caimi PF , Rajguru S , Evens A , Klein A , Umyarova E , Pulluri B , Amengual JE , Lue JK , Diefenbach C , Fisher RI , Barta SK
Survival Outcomes of Younger Patients With Mantle Cell Lymphoma Treated in the Rituximab Era
J Clin Oncol. 2019 Feb 20;37(6) :471-480
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Abstract
PURPOSE: Mantle cell lymphoma (MCL) is a B-cell lymphoma characterized by cyclin D1 expression. Autologous hematopoietic cell transplantation (AHCT) consolidation after induction chemotherapy is often used for eligible patients; however, the benefit remains uncertain in the rituximab era. Herein we retrospectively assessed the impact of AHCT consolidation on survival in a large cohort of transplantation-eligible patients age 65 years or younger. PATIENTS AND METHODS: We retrospectively studied transplantation-eligible adults age 65 years or younger with newly diagnosed MCL treated between 2000 and 2015. The primary objective was to assess for improved progression-free survival (PFS) with AHCT consolidation and secondarily to assess for improved overall survival (OS). Cox multivariable regression analysis and propensity score-weighted (PSW) analysis were performed. RESULTS: Data were collected from 25 medical centers for 1,254 patients; 1,029 met inclusion criteria. Median follow-up for the cohort was 76 months. Median PFS and OS were 62 and 139 months, respectively. On unadjusted analysis, AHCT was associated with improved PFS (75 v 44 months with v without AHCT, respectively; P < .01) and OS (147 v 115 months with v without AHCT, respectively; P < .05). On multivariable regression analysis, AHCT was associated with improved PFS (hazard ratio [HR], 0.54; 95% CI, 0.44 to 0.66; P < .01) and a trend toward improved OS (HR, 0.77; 95% CI, 0.59 to 1.01; P = .06). After PSW analysis, AHCT remained associated with improved PFS (HR, 0.70; 95% CI, 0.59 to 0.84; P < .05) but not improved OS (HR, 0.87; 95% CI, 0.69 to 1.1; P = .2). CONCLUSION: In this large cohort of younger, transplantation-eligible patients with MCL, AHCT consolidation after induction was associated with significantly improved PFS but not OS after PSW analysis. Within the limitations of a retrospective analysis, our findings suggest that in younger, fit patients, AHCT consolidation may improve PFS.
Notes
1527-7755 Gerson, James N Handorf, Elizabeth Villa, Diego Gerrie, Alina S Chapani, Parv Li, Shaoying Medeiros, L Jeffrey Wang, Michael I Cohen, Jonathon B Calzada, Oscar Churnetski, Michael C Hill, Brian T Sawalha, Yazeed Hernandez-Ilizaliturri, Francisco J Kothari, Shalin Vose, Julie M Bast, Martin A Fenske, Timothy S Narayana Rao Gari, Swapna Maddocks, Kami J Bond, David Bachanova, Veronika Kolla, Bhaskar Chavez, Julio Shah, Bijal Lansigan, Frederick Burns, Timothy F Donovan, Alexandra M Wagner-Johnston, Nina Messmer, Marcus Mehta, Amitkumar Anderson, Jennifer K Reddy, Nishitha Kovach, Alexandra E Landsburg, Daniel J Glenn, Martha Inwards, David J Karmali, Reem Kaplan, Jason B Caimi, Paolo F Rajguru, Saurabh Evens, Andrew Klein, Andreas Umyarova, Elvira Pulluri, Bhargavi Amengual, Jennifer E Lue, Jennifer K Diefenbach, Catherine Fisher, Richard I Barta, Stefan K Journal Article United States J Clin Oncol. 2019 Feb 20;37(6):471-480. doi: 10.1200/JCO.18.00690. Epub 2019 Jan 7.