Pretransplantation Minimal Residual Disease Predicts Survival in Patients with Mantle Cell Lymphoma Undergoing Autologous Stem Cell Transplantation in Complete Remission

Pretransplantation Minimal Residual Disease Predicts Survival in Patients with Mantle Cell Lymphoma Undergoing Autologous Stem Cell Transplantation in Complete Remission

Transplantation and Cellular Therapy, September 2015

26348890

Andrew J. Cowan, Philip A. Stevenson, Ryan D. Cassaday, Solomon A. Graf, Jonathan R. Fromm, David Wu, Leona A. Holmberg, Brian G. Till, Thomas R. Chauncey, Stephen D. Smith, Mary Philip, Johnnie J. Orozco, Andrei R. Shustov, Damian J. Green, Edward N. Libby, William I. Bensinger, Mazyar Shadman, David G. Maloney, Oliver W. Press, Ajay K. Gopal

Autologous stem cell transplantation (ASCT) is standard therapy for mantle cell lymphoma (MCL) in remission following induction chemotherapy with the best results for patients in complete remission (CR). We hypothesized that evaluation of MRD prior to ASCT could further stratify outcomes for these patients. Patients with MCL who underwent ASCT in clinical CR between 1996 and 2011, with pretransplant MRD testing were eligible. Presence of a clonal IgH rearrangement, t(11;14) by PCR, or positive flow cytometry from blood or bone marrow was considered positive. An adjusted proportional hazards model for associations with progression-free (PFS) and overall survival (OS) was performed. Of 75 MCL patients in CR, 8 (11%) were MRD positive. MRD positivity was associated with shorter OS and PFS. The median OS for MRD-negative patients was not reached with 82% survival at 5 years, while for the MRD-positive patients was 3.01 years (hazard ratio [HR] 4.04, p = 0.009), with a median follow-up of 5.1 years. The median PFS for MRD-negative patients was not reached with 75 % PFS at 5 years, while for MRD-positive patients was 2.38 years (HR 3.69, p = 0.002). MRD positivity is independently associated with poor outcome following ASCT for MCL patients in CR.