Strategies to optimize collection of hematopoietic stem cells in patients with mantle cell lymphoma receiving hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone combined with cytarabine and methotrexate (Hyper-CVAD) chemotherapy.

摘要

Mantle cell lymphoma (MCL) has aptly been described as a lymphoma with features of 'the worst of both worlds,' being both incurable and aggressive, historically with a median survival of 3-5 years despite intensive therapy. Autologous stem cell transplant (ASCT) has a clear role, as consolidation after primary response [1], as salvage after a suboptimal response, or as salvage after relapse, with superior overall survival demonstrated in patients with chemo-sensitive disease undergoing ASCT after R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincris-tine, and prednisone) therapy [2]. The use of intensive regimens such as Hyper-CVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dex-amethasone combined with cytarabine and methotrex-ate) [3] for MCL has the benefit of improved rates of remission, and greatly enhanced complete remission rates, but each consecutive cycle carries an incremental negative impact on the ability to mobilize and collect adequate numbers of hematopoietic stem and progenitor cells (HSPCs) due to presumed stem cell toxicity [4].