Annals of hematology · 2025
"B" symptoms and CBV conditioning negatively impact survival in mantle cell lymphoma patients undergoing autologous stem cell transplantation.
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Chromik Karolina, Wieczorkiewicz-Kabut Agata, Zielińska Patrycja, Koclęga Anna, Kadłubek Sabina, Kamiński Jakub, Helbig Grzegorz
Аннотация
INTRODUCTION: Mantle cell lymphoma (MCL) is an aggressive B-cell non-Hodgkin lymphoma with limited curative options. Autologous stem cell transplantation (ASCT) is widely used as consolidation in younger, fit patients. This study aimed to evaluate long-term outcomes after ASCT and identify clinical factors influencing survival.
METHODS: This retrospective study included 119 patients with MCL who underwent ASCT between 2007 and 2024 in first complete or partial remission. Patient characteristics, outcomes, and transplant-related complications were assessed.
RESULTS: At 3 and 5 years, overall survival (OS) rates were 78.3% and 75.2%; progression-free survival (PFS) rates were 76.6% and 73.4%. Median OS and PFS were not reached. The presence of B symptoms at diagnosis and use of CBV (cyclophosphamide, carmustine, and etoposide) conditioning were independently associated with inferior OS and PFS. In contrast, BeEAM (bendamustine, etoposide, cytarabine, melphalan) conditioning was associated with improved outcomes. Treatment-related mortality at day 100 was 3.4%. Post-transplant complications occurred in 64% of patients, most commonly infections and mucositis. Rituximab maintenance was used in only 17% of cases. The median time to relapse was 13 months, and relapse remained the leading cause of treatment failure.
CONCLUSIONS: ASCT remains a safe and effective consolidation approach in MCL, offering favorable long-term survival. However, the presence of B symptoms and use of CBV conditioning are associated with worse outcomes. These findings underscore the need for risk-adapted treatment strategies and the broader implementation of post-transplant maintenance to enhance disease control.
METHODS: This retrospective study included 119 patients with MCL who underwent ASCT between 2007 and 2024 in first complete or partial remission. Patient characteristics, outcomes, and transplant-related complications were assessed.
RESULTS: At 3 and 5 years, overall survival (OS) rates were 78.3% and 75.2%; progression-free survival (PFS) rates were 76.6% and 73.4%. Median OS and PFS were not reached. The presence of B symptoms at diagnosis and use of CBV (cyclophosphamide, carmustine, and etoposide) conditioning were independently associated with inferior OS and PFS. In contrast, BeEAM (bendamustine, etoposide, cytarabine, melphalan) conditioning was associated with improved outcomes. Treatment-related mortality at day 100 was 3.4%. Post-transplant complications occurred in 64% of patients, most commonly infections and mucositis. Rituximab maintenance was used in only 17% of cases. The median time to relapse was 13 months, and relapse remained the leading cause of treatment failure.
CONCLUSIONS: ASCT remains a safe and effective consolidation approach in MCL, offering favorable long-term survival. However, the presence of B symptoms and use of CBV conditioning are associated with worse outcomes. These findings underscore the need for risk-adapted treatment strategies and the broader implementation of post-transplant maintenance to enhance disease control.