Autologous hematopoietic stem cell transplant (HSCT) provides a long-term survival benefit, when compared with interferon (IFN)-alfa maintenance, in patients with advanced mantle cell lymphoma (MCL), according to research published in The Lancet Haematology.¹
Prior results from this study showed a progression-free survival (PFS) benefit with autologous HSCT, but it wasn’t clear if HSCT improved overall survival (OS).² The current results show a significant improvement in PFS and OS at a median follow-up of 14 years.
Researchers conducted a post-hoc analysis of a phase 3 trial designed to compare autologous HSCT with IFN-alfa maintenance after induction with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) in patients with MCL.
The intention-to-treat population consisted of 174 patients who responded to induction with CHOP (n=88) or rituximab plus CHOP (n=68). The patients were then randomly assigned to receive autologous HSCT (n=93) or IFN-alfa (n=81).
The median follow-up was 14 years. The median PFS was 3.3 years in the autologous HSCT arm and 1.5 years in the IFN-alfa maintenance arm (adjusted hazard ratio [aHR], 0.50; 95% CI, 0.36-0.69; P <.0001).
The median OS was 7.5 years in the HSCT arm and 4.8 years for those receiving IFN-alfa (aHR, 0.66; 95% CI, 0.46-0.95; P =.019).
Among patients who received a rituximab-free induction regimen, the PFS and OS were significantly longer with autologous HSCT than with IFN-alfa. The median PFS was 3.1 years in the HSCT arm and 1.2 years in the IFN-alpha arm (aHR, 0.40; 95% CI, 0.26-0.61; P <.0001). The median OS was 6.7 years and 4.3 years, respectively (aHR, 0.52; 95% CI, 0.33-0.82; P =.016).
Among patients who received rituximab as part of induction, the PFS and OS were similar with autologous HSCT and IFN-alfa. The median PFS was 3.4 years in the HSCT arm and 1.7 years in the IFN-alpha arm (aHR, 0.72; 95% CI, 0.42-1.24; P =.087). The median OS was 9.6 years and 5.5 years, respectively (aHR, 1.05; 95% CI, 0.55-1.99; P =.68).
“[T]hese data from the first randomized phase 3 trial of the European Mantle Cell Lymphoma Network underline the relevance of a post-induction autologous HSCT in the context of a CHOP-like induction therapy,” the study authors wrote.
“The suggested reduced efficacy after immunochemotherapy supports the need for its re-evaluation now that antibody maintenance, high-dose cytarabine, and targeted treatments have changed the standard of care for patients with mantle cell lymphoma.”
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
¹Zoellner A-K, Unterhalt M, Stilgenbauer S, et al. Long-term survival of patients with mantle cell lymphoma after autologous haematopoietic stem-cell transplantation in first remission: A post-hoc analysis of an open-label, multicentre, randomised, phase 3 trial. Lancet Haematol. 2021;8(9):e648-e657. doi:10.1016/S2352-3026(21)00195-2
²Dreyling M, Lenz G, Hoster E, et al. Early consolidation by myeloablative radiochemotherapy followed by autologous stem cell transplantation in first remission significantly prolongs progression-free survival in mantle-cell lymphoma: Results of a prospective randomized trial of the European MCL Network. Blood. 2005;105(7):2677-84. doi:10.1182/blood-2004-10-3883