Autologous and allogeneic stem cell transplantation: Rising therapeutic promise for mantle cell lymphoma

Mantle cell lymphoma (MCL) is currently an incurable neoplasm with a median survival duration of 3-5 years. The clinical results of therapy with cyclophosphamide, doxorubicin, vincristine, and prednisone or similar regimens are inadequate, leading to widespread exploration of the use of autologous stem cell transplantation (ASCT) during the first remission. In the pre-rituximab era, early ASCT extended the median remission duration by 1-2 years, but most patients eventually experienced relapse. With the advent of rituximab and its incorporation into stem cell mobilization and conditioning regimens, several research groups have reported improved outcomes, including the emergence of early survival curve plateaus that suggest a cured fraction. Intensive chemoimmunotherapy with rituximab and hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone has been reported to have similarly favorable results. Therefore, the addition of rituximab to intensive chemotherapy or ASCT regimens may be curative in patients undergoing frontline treatment for MCL. In the relapsed or refractory disease setting, the clinical results of ASCT remain inadequate. However, the increasing safety and high efficacy of non-myeloablative stem cell transplantation (SCT) suggests that it is the most appropriate transplantation modality in patients with relapsed or refractory MCL when a suitable donor is available.