Transplantation in patients with diffuse mantle cell lymphoma in first disease remission the prognostic value of β2-microglobulin and the tumor score

BACKGROUND. The current study was conducted to analyze the long-term results of autologous stein cell transplantation (ASCT) in patients with diffuse mantle cell lymphoma (MCL) in first disease remission. METHODS. Thirty-three patients were treated. Thirty-one patients had Ann Arbor Stage III or Stage IV disease. The hyper-CVAD regimen (hyperfractionated intense-dose cyclophosphamide, vincristine, continuous intravenous infusion of doxorubicin, and dexamethasone, alternating with high doses of cytarabine and methotrexate plus leucovorin rescue) was used for cytoreduction before ASCT. Patients were consolidated with high-dose cyclophosphamide (120 mg/kg), total body irradiation, and ASCT. RESULTS. At a median follow-up of 49 months, the overall survival and disease-free-survival rates at 5 years were estimated to be 77% and 43%, respectively. Patients whose M. D. Anderson Lymphoma Tumor Score (TS) was less than or equal to 1 at the time of diagnosis or transplantation experienced longer disease-free survival compared with those whose TS was > 1 (P = 0.02). A beta(2)-microglobulin (beta(2)m) level less than or equal to 3 mg/L at the time of diagnosis or transplantation was also found to be strongly predictive of longer survival (5-year survival rate of 100% vs. 22% in patients with a beta(2)m level > 3 mg/L) (P = 0.0001). CONCLUSIONS. ASCT may prolong the overall survival in a subset of patients with MCL. This improvement has been observed for the most part in patients with low beta(2)m levels (less than or equal to 3 mg/L) and TS (less than or equal to 1). Randomized trials are required to fully assess the benefits of this strategy. (C) 2003 American Cancer Society.