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Lymphoma

The EBMT/EMCL consensus project on the role of autologous and allogeneic stem cell transplantation in mantle cell lymphoma

Leukemia volume 29, pages 464–473 (2015)Cite this article

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Abstract

The role of both autologous (autoSCT) and allogeneic stem cell transplantation (alloSCT) in the management of mantle cell lymphoma (MCL) remains to be clarified. We conducted a consensus project using the RAND-modified Delphi consensus procedure to provide guidance on how SCT should be used in MCL. With regard to autoSCT, there was consensus in support of: autoSCT is the standard first-line consolidation therapy; induction therapy should include high-dose cytarabine and Rituximab; complete or partial remission should be achieved before autoSCT; Rituximab maintenance following autoSCT is not indicated; and omission of autoSCT in ‘low-risk’ patients is not indicated. No consensus could be reached regarding: autoSCT in the treatment of relapsed disease following non-transplant therapy; the value of positron emission tomography scanning and minimal residual disease (MRD) monitoring; in vivo purging with Rituximab; total body irradiation conditioning for autoSCT; and preemptive Rituximab after autoSCT. For alloSCT, consensus was reached in support of: alloSCT should be considered for patients relapsing after autoSCT; reduced intensity conditioning regimens should be used; allogeneic immunotherapy should be used for MRD eradication after alloSCT; and there is a lack of prognostic criteria to guide the use of alloSCT as first-line consolidation. No consensus was reached regarding the role of alloSCT for relapsed disease following non-transplant therapy.

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Authors and Affiliations

  1. BMT Unit, University Hospital Bristol, Bristol, UK,

    S Robinson

  2. University of Heidelberg, Medizinische Klinik, Heidelberg, Germany

    P Dreger

  3. Hospital Clínico Servicio de Hematologica, Salamanca, Spain

    D Caballero

  4. Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milano, Milano, Italy

    P Corradini

  5. BMT Unit, Rigshospitalet, Copenhagen, Denmark

    C Geisler

  6. Oncology Institute of Southern Switzerland, Bellinzona, Switzerland

    M Ghielmini

  7. CHU Nantes, Nantes, France

    S Le Gouill

  8. Department Of Haematology, Karolinska University Hospital, Stockholm, Sweden

    E Kimby

  9. Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth, UK

    S Rule

  10. Department of Oncology and Hematology, ‘Città della Salute e della Scienza’ University Hospital, Torino, Italy

    U Vitolo

  11. Department of Haemato-Oncology, University of Munich, Munich, Germany,

    M Dreyling

  12. Hôpital Necker, Service Hematologie Adulte, Paris, France

    O Hermine

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on behalf of the European MCL Network and the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation

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Correspondence to S Robinson.

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Both MD and SR have received research honoraria from Roche. The other authors declare no conflict of interest.

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Appendix 1. The Grading System

Appendix 1. The Grading System

The GRADE nomenclature for assessing the strength of each recommendation and the level of evidence supporting each recommendation was adopted for each statement where there was a consensus (complete or partial) for or against.

Strength of recommendations

The strength of the recommendation is graded as either strong or weak.

Strong (grade 1): Strong recommendations (grade 1) are made when there is confidence that the benefits do or do not outweigh harm and burden. Grade 1 recommendations can be applied uniformly to most patients.

Weak (grade 2): Where the magnitude of benefit or not is less certain a weaker grade 2 recommendation is made. Grade 2 recommendations require judicious application to individual patients.

Quality of evidence

The quality of evidence is graded as high (A), moderate (B) or low (C).

(A) High: Further research is very unlikely to change confidence in the estimate of effect. Current evidence derived from randomized clinical trials without important limitations.

(B) Moderate: Further research may well have an important impact on confidence in the estimate of effect and may change the estimate. Current evidence derived from randomized clinical trials with important limitations (for example inconsistent results, imprecision; wide confidence intervals or methodological flaws; for example lack of blinding, large losses to follow up, failure to adhere to intention-to-treat analysis), or very strong evidence from observational studies or case series (for example large or very large and consistent estimates of the magnitude of a treatment effect or demonstration of a dose–response gradient).

(C) Low: Further research is likely to have an important impact on confidence in the estimate of effect and is likely to change the estimate. Current evidence from observational studies, case series or just opinion.

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Robinson, S., Dreger, P., Caballero, D. et al. The EBMT/EMCL consensus project on the role of autologous and allogeneic stem cell transplantation in mantle cell lymphoma. Leukemia 29, 464–473 (2015). https://doi.org/10.1038/leu.2014.223

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