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      Rituximab after Autologous Stem-Cell Transplantation in Mantle-Cell Lymphoma.

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          Abstract

          Mantle-cell lymphoma is generally incurable. Despite high rates of complete response after initial immunochemotherapy followed by autologous stem-cell transplantation, patients have relapses. We investigated whether rituximab maintenance therapy at a dose of 375 mg per square meter of body-surface area administered every 2 months for 3 years after transplantation would prolong the duration of response.

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          A new prognostic index (MIPI) for patients with advanced-stage mantle cell lymphoma.

          Eva Hoster, Martin Dreyling, Wolfram Klapper … (2008)
          There is no generally established prognostic index for patients with mantle cell lymphoma (MCL), because the International Prognostic Index (IPI) and Follicular Lymphoma International Prognostic Index (FLIPI) have been developed for diffuse large cell and follicular lymphoma patients, respectively. Using data of 455 advanced stage MCL patients treated within 3 clinical trials, we examined the prognostic relevance of IPI and FLIPI and derived a new prognostic index (MCL international prognostic index, MIPI) of overall survival (OS). Statistical methods included Kaplan-Meier estimates and the log-rank test for evaluating IPI and FLIPI and multiple Cox regression for developing the MIPI. IPI and FLIPI showed poor separation of survival curves. According to the MIPI, patients were classified into low risk (44% of patients, median OS not reached), intermediate risk (35%, 51 months), and high risk groups (21%, 29 months), based on the 4 independent prognostic factors: age, performance status, lactate dehydrogenase (LDH), and leukocyte count. Cell proliferation (Ki-67) was exploratively analyzed as an important biologic marker and showed strong additional prognostic relevance. The MIPI is the first prognostic index particularly suited for MCL patients and may serve as an important tool to facilitate risk-adapted treatment decisions in patients with advanced stage MCL.
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            Long-term progression-free survival of mantle cell lymphoma after intensive front-line immunochemotherapy with in vivo-purged stem cell rescue: a nonrandomized phase 2 multicenter study by the Nordic Lymphoma Group.

            Christian H Geisler, Arne Kolstad, Anna Laurell … (2008)
            Mantle cell lymphoma (MCL) is considered incurable. Intensive immunochemotherapy with stem cell support has not been tested in large, prospective series. In the 2nd Nordic MCL trial, we treated 160 consecutive, untreated patients younger than 66 years in a phase 2 protocol with dose-intensified induction immunochemotherapy with rituximab (R) + cyclophosphamide, vincristine, doxorubicin, prednisone (maxi-CHOP), alternating with R + high-dose cytarabine. Responders received high-dose chemotherapy with BEAM or BEAC (carmustine, etoposide, cytarabine, and melphalan/cyclophosphamide) with R-in vivo purged autologous stem cell support. Overall and complete response was achieved in 96% and 54%, respectively. The 6-year overall, event-free, and progression-free survival were 70%, 56%, and 66%, respectively, with no relapses occurring after 5 years. Multivariate analysis showed Ki-67 to be the sole independent predictor of event-free survival. The nonrelapse mortality was 5%. The majority of stem cell products and patients assessed with polymerase chain reaction (PCR) after transplantation were negative. Compared with our historical control, the Nordic MCL-1 trial, the event-free, overall, and progression-free survival, the duration of molecular remission, and the proportion of PCR-negative stem cell products were significantly increased (P < .001). Intensive immunochemotherapy with in vivo purged stem cell support can lead to long-term progression-free survival of MCL and perhaps cure. Registered at www.isrctn.org as #ISRCTN 87866680.
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              Addition of high-dose cytarabine to immunochemotherapy before autologous stem-cell transplantation in patients aged 65 years or younger with mantle cell lymphoma (MCL Younger): a randomised, open-label, phase 3 trial of the European Mantle Cell Lymphoma Network.

              Olivier Hermine, Eva Hoster, Jan Walewski … (2016)
              Mantle cell lymphoma is characterised by a poor long-term prognosis. The European Mantle Cell Lymphoma Network aimed to investigate whether the introduction of high-dose cytarabine to immunochemotherapy before autologous stem-cell transplantation (ASCT) improves outcome.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): N. Engl. J. Med.
                Title: The New England journal of medicine
                Publisher: New England Journal of Medicine (NEJM/MMS)
                ISSN (Electronic): 1533-4406
                ISSN (Print): 0028-4793
                Publication date (Electronic): September 28 2017
                Volume: 377
                Issue: 13
                Affiliations
                [1 ] From Service d'Hématologie Clinique (S.L.G., T.G.), Service d'Anatomopathologie (A.M.), and Service d'Hématologie Biologique (M.C.B.), Hôtel-Dieu Centre Hospitalier Universitaire (CHU) de Nantes, and Centre de Recherche en Cancérologie et Immunologie (S.L.G., M.C.B.) and Faculté de Médecine (S.L.G.), Université de Nantes, Nantes, Hemato-Oncologie, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Saint-Louis, Université Diderot Sorbonne Paris-Cité (C.T.), Université Descartes (C.T.), Département d'Hématologie, Faculté de Médecine, Université Paris-Sud (V.R.), Département d'Anatomopathologie (D.C.) and Département d'Hématologie (O.H.), Necker Hospital, APHP, Sorbonne Paris-Cité, and INSERM Unité 1163 et Centre National de la Recherche Scientifique (CNRS) Équipe de Recherche Labellisée 8654, Imagine Institute (O.H.), Paris, Département d'Hématologie, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse (L.O.), Service d'Hématologie Clinique et Thérapie Cellulaire, CHU de Bordeaux, Bordeaux (K.B.), Service d'Hématologie et Thérapie Cellulaire, CHU de Tours, Tours (C.D.), Service d'Hématologie, CHU d'Amiens, Amiens (G.D.), INSERM, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif (V.R.), Département d'Hématologie, CHU de Nancy, Nancy (P.F.), INSERM Unité 954, Vandoeuvre (P.F.), Service d'Hématologie Clinique, CHU de Dijon, and INSERM Unité Mixte de Recherche 1231, Dijon (O.C.), Service d'Hématologie, Centre Hospitalier d'Avignon, Avignon (H.Z.), Lymphoid Malignancies Unit, Hôpital Henri Mondor, APHP, Créteil (C.H.), Service d'Hématologie du Centre Hospitalier de Vendée, La Roche-sur-Yon (H.M.), Service Hématologie Clinique (R.H.) and Département d'Hématologie (T.L.), CHU de Rennes, INSERM Unité 917 (R.H.), and INSERM Unité 1236 (T.L.), Rennes, Département d'Hematology, Centre Henri-Becquerel et Université de Normandie Unité 1245, Rouen (F.J., H.T.), Service d'Hématologie Clinique Adulte et de Thérapie Cellulaire, CHU de Clermont-Ferrand et Université Clermont Auvergne, Clermont-Ferrand (O.T.), Service d'Hématologie, Clinique Victor Hugo, Le Mans (K.L.D.), Department of Hematology, Université de Lille, Groupe de Recherche sur les Formes Injectables et les Technologies Associées, and CHU de Lille, Lille (F.M.), Département d'Hématologie Clinique, CHU de Montpellier, CNRS UMR 5235, Montpellier (G.C.), Service d'Oncologie et d'Hématologie, Hôpitaux Universitaires de Strasbourg, Strasbourg (L.-M.F.), INSERM 1209, CNRS UMR 5309, Faculté de Médecine, Université Grenoble Alpes (M.C., R.G.), Institute for Advanced Biosciences (M.C.), and Laboratoire de Génétique Onco-hématologie (M.C.) and Faculté de Médecine (R.G.), CHU de Grenoble Alpes, Grenoble, Service d'Hématologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite (G.S.), and Université Claude Bernard Lyon 1 and Cancer Research Center of Lyon, INSERM 1052 CNRS 5286 Lyon, Lyon (G.S.) - all in France; and Département d'Hématologie, Cliniques Universitaires Saint-Luc-Université Catholique de Louvain, Brussels (E.V.D.N.).
                Article
                DOI: 10.1056/NEJMoa1701769
                PubMed ID: 28953447
                SO-VID: b85804a0-d08d-4bfd-9a12-c02ae17955ab
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