Retrospective analysis of clinical outcomes and risk factors in hematopoietic cell transplantation for relapsed or refractory mantle cell lymphoma in the post-ibrutinib era

Ibrutinib, a Bruton tyrosine kinase inhibitor, has improved outcomes for patients with relapsed or refractory mantle cell lymphoma, yet prognosis remains inadequate for many. The choice between high-dose therapy with autologous hematopoietic cell transplantation (HCT) and allogeneic HCT remains a topic of debate in this patient population. This Japanese retrospective study (2017–2023) analyzed 155 patients with relapsed or refractory mantle cell lymphoma receiving autologous (n = 105) or allogeneic HCT (n = 50). Autologous and allogeneic HCT showed comparable efficacy, with similar median OS (28 vs. 27 months). However, outcome predictors differed significantly. Autologous HCT: age > 60 years predicted worse OS (hazard ratio [HR] = 2.73) and allogeneic HCT: early progression surrogate based on diagnosis-to-HCT interval ≤ 24 months and relapsed or refractory status at HCT (HR = 4.10) and non-complete remission (HR = 3.53) correlated with poorer outcomes. Ibrutinib integration demonstrated critical benefits: post-autologous relapse patients receiving ibrutinib had superior 2-year OS (57% vs. 25%, P = 0.035), and no transplant-related mortality occurred in allogeneic HCT patients on ibrutinib (n = 10). This study confirms HCT use in the ibrutinib era, highlighting age, disease kinetics, and targeted therapy as key prognostic factors, and supports risk-adapted strategies combining HCT with novel agents like ibrutinib to optimize outcomes for high-risk mantle cell lymphoma.