Cytarabine, Ki-67, and SOX11 in patients with mantle cell lymphoma receiving rituximab-containing autologous stem cell transplantation during first remission

Authors

  • Zaher I. Chakhachiro MD,

    1. Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Rima M. Saliba MD,

    1. Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Grace-Julia Okoroji MD,

    1. Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Martin Korbling MD,

    1. Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Amin M. Alousi MD,

    1. Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Oran Betul MD,

    1. Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Paolo Anderlini MD,

    1. Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Stefan O. Ciurea MD,

    1. Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Uday Popat MD,

    1. Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Richard Champlin MD,

    1. Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Barry I. Samuels MD,

    1. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • L. Jeffrey Medeiros MD,

    1. Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Carlos Bueso-Ramos MD,

    1. Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Issa F. Khouri MD

    Corresponding author
    1. Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
    • Corresponding author: Issa F. Khouri, MD, Department of Stem Cell Transplantation and Cellular Therapy, Unit 423, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; Fax: (713) 794-4902; ikhouri@mdanderson.org

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  • Presented in part as an abstract at the 53rd Annual Meeting of the American Society of Hematology; December 10-13 2011; San Diego, CA.

  • We thank Martin H. Nguyen for his technical assistance and Dr. Roberto N. Miranda for providing the tissue microarray that helped us optimize SOX11 immunohistochemical staining. We also thank all the pathologists and hematooncologists from outside our institution for providing paraffin blocks or unstained sections for SOX11 immunohistochemical analysis. We thank Ann Sutton for her editing of this article.

Abstract

BACKGROUND

In the current study, the authors report the results of 39 patients with mantle cell lymphoma (MCL) who were treated with chemotherapy and high-dose rituximab-containing autologous stem cell transplantation (ASCT) during their first disease remission.

METHODS

The median age of the patients was 54 years. At the time of diagnosis, 87% of patients had Ann Arbor stage IV disease, and 77% had bone marrow involvement. A Ki-67 level of > 30% was found in 11 of 27 patients (40%), and SOX11 (SRY [sex determining region Y)-box 11] expression was found to be positive in 17 of 18 patients (94%). Twenty-seven patients (69%) underwent induction therapy with high-dose cytarabine-containing chemotherapy. Rituximab was administered during stem cell collection at a dose of 1000 mg/m2 on days +1 and +8 after ASCT.

RESULTS

The estimated 4-year overall survival and progression-free survival rates were 82% and 59%, respectively. Twelve patients experienced disease recurrence. Fifteen of 16 patients who were alive and in complete remission at 36 months remained so at a median follow-up of 69 months (range, 38 months-145 months). The only determinant of recurrence risk found was a Ki-67 level of > 30%. Seven of 11 patients with a Ki-67 level > 30% experienced disease recurrence within the first 3 years versus only 3 of 16 patients with a Ki-67 level ≤ 30% (P = .02). Patients who received high-dose cytarabine did not have a significantly different risk of developing disease recurrence compared with other patients (P = .7).

CONCLUSIONS

Administering ASCT with rituximab during stem cell collection and immediately after transplantation may induce a continuous long-term disease remission in patients with MCL with a Ki-67 level of ≤ 30%. Cancer 2013;119:3318–25. © 2013 American Cancer Society.

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