Molecular remission is an independent predictor of clinical outcome in patients with mantle cell lymphoma after combined immunochemotherapy: a European MCL intergroup study.
The prognostic impact of minimal residual disease (MRD) was analyzed in 259 patients with mantle cell lymphoma (MCL) treated within 2 randomized trials of the European MCL Network (MCL Younger and MCL Elderly trial). After rituximab-based induction treatment, 106 of 190 evaluable patients (56%) achieved a molecular remission (MR) based on blood and/or bone marrow (BM) analysis. MR resulted in a significantly improved response duration (RD; 87% vs 61% patients in remission at 2 years, P = .004) and emerged to be an independent prognostic factor for RD (hazard ratio = 0.4, 95% confidence interval, 0.1-0.9, P = .028). MR was highly predictive for prolonged RD independent of clinical response (complete response [CR], complete response unconfirmed [CRu], partial response [PR]; RD at 2 years: 94% in BM MRD-negative CR/CRu and 100% in BM MRD-negative PR, compared with 71% in BM MRD-positive CR/CRu and 51% in BM MRD-positive PR, P = .002). Sustained MR during the postinduction period was predictive for outcome in MCL Younger after autologous stem cell transplantation (ASCT; RD at 2 years 100% vs 65%, P = .001) and during maintenance in MCL Elderly (RD at 2 years: 76% vs 36%, P = .015). ASCT increased the proportion of patients in MR from 55% before high-dose therapy to 72% thereafter. Sequential MRD monitoring is a powerful predictor for treatment outcome in MCL. These trials are registered at www.clinicaltrials.gov as #NCT00209222 and #NCT00209209.
Pott
Christiane
C
Second Medical Department, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Hoster
Eva
E
Delfau-Larue
Marie-Helene
MH
Beldjord
Kheira
K
Böttcher
Sebastian
S
Asnafi
Vahid
V
Plonquet
Anne
A
Siebert
Reiner
R
Callet-Bauchu
Evelyne
E
Andersen
Niels
N
van Dongen
Jacques J M
JJ
Klapper
Wolfram
W
Berger
Françoise
F
Ribrag
Vincent
V
van Hoof
Achiel L
AL
Trneny
Marek
M
Walewski
Jan
J
Dreger
Peter
P
Unterhalt
Michael
M
Hiddemann
Wolfgang
W
Kneba
Michael
M
Kluin-Nelemans
Hanneke C
HC
Hermine
Olivier
O
Macintyre
Elizabeth
E
Dreyling
Martin
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002469:Cell Separation; D003131:Combined Modality Therapy; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007150:Immunohistochemistry; D007167:Immunotherapy / Q000379:methods; D020522:Lymphoma, Mantle-Cell / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D016133:Polymerase Chain Reaction; D011379:Prognosis; D011878:Radiotherapy; D016896:Treatment Outcome