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Abstract
Although the overall survival has improved significantly in mantle cell lymphoma, relapsed disease remains a challenge. It has been demonstrated that high-dose cytarabine- and rituximab-containing regimens in induction improve response rate before autologous stem cell transplantation. This therapeutic strategy performed in first-line therapy improves significantly both progression-free survival and overall survival and has emerged as a new standard of care in younger patients. The role of allogeneic stem cell transplantation and its place in the treatment algorithm is not fully established, but may be a curative strategy. However, new therapeutic strategies such as maintenance/preemptive therapy or novel targeted therapies may challenge and change the indications of stem cell transplantation. This review will discuss the role of stem cell transplantation in mantle cell lymphoma and how emerging treatment strategies and novel therapies may challenge the current paradigms of therapy.
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.
No writing assistance was utilized in the production of this manuscript.
Autologous stem cell transplantation has become a standard of care for younger patients in first complete remission.
The advantage of this therapeutic strategy may be challenged only in the context of clinical trial in patients with a low or intermediate Mantle cell International Prognosis Index score disease.
Complete or partial clinical remission preferentially with HARA-C and rituximab should be achieved prior to autologous stem cell transplantation.
The role of molecular minimal residual disease or PET scan to tailor the treatment is encouraging but not yet fully established.
Mantle cell lymphoma (MCL) can now be regarded as a heterogeneous disease, with some patients achieving long-term disease control and perhaps cure, while other patients have aggressive disease and may benefit from more intensive treatment.
Some patients with indolent MCL may benefit from an initial watch-and-wait strategy.
Despite its potential toxicity, allogeneic stem cell transplantation can be offered to eligible patients with a primary refractory or relapsing disease.
A risk-adapted strategy is not yet feasible due to the absence of a proven prognostic stratification at diagnosis.
The increasing understanding of MCL biology has led to the development of novel targeted approaches, which will challenge current treatment strategies.