The question we had asked ourselves is do patients with mantle cell lymphoma who are younger than 65, or 65 and younger, still benefit from high doses of chemotherapy in consolidation with autologous stem cell transplant after induction therapy in the era of rituximab and other new biological agents. We were able to get data for over a thousand patients from thirty centres within the United States and Canada to answer that question.
Can you tell me a bit about the methodology there, how you used this data?
We got patient level data from these over thirty institutions and we analysed them for progression free survival and overall survival. We looked at the initial induction regimen, we looked at well-established biological prognostic features and we looked at also treatment related morbidity and treatment related mortality.
What did you find?
What we found was that patients do appear to benefit in terms of survival from having consolidation with an autologous stem cell transplant after their first induction chemotherapy. It translated into a progression free survival and it also translated into an overall survival benefit of the patients who achieved a transplant versus those who did not get a transplant. The benefit was in the range of about 20% and it also appeared, though, that specifically the patients with high risk factors such as blastoid morphology or high MIPI scores benefitted the most.
So the potential impact of this?
At this point in time we really don’t have any prospective study to inform whether autologous stem cell transplant is still of benefit in this era. Our study confirms the current practice of what most centres practice – to consolidate the response, the initial response, with high doses of chemotherapy. So it helps support the current standard of care. It doesn’t really answer, because there clearly is an inherent selection bias and things that we could not collect in what drives the physicians’ decision to transplant one patient and not transplant another patient, so it is really not a substitute for a randomised trial but it certainly supports what physicians are currently doing. Hopefully this will be followed up with prospective studies that look at maybe which patients can avoid the stem cell transplant, for example certain low risk patients might be able to have the same survival without the high doses of chemotherapy and stem cell transplant consolidation.