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Role of MRD in Rituximab Maintenance for Older Patients With Mantle Cell Lymphoma

By: Emily Rhode
Posted: Tuesday, January 24, 2023

Measurable residual disease (MRD) status appears to be a valuable prognostic indicator of the efficacy of rituximab maintenance after immunochemotherapy in elderly patients with previously untreated, advanced-stage mantle cell lymphoma, according to Eva Hoster, PhD, of Ludwig-Maximilian University, Munich, and colleagues. Their findings, which were presented during the 2022 American Society of Hematology Association (ASH) Annual Meeting and Exposition (Abstract 544), were part of an investigation within the European Mantle Cell Lymphoma Elderly trial.

β€œThe results confirm the strong efficacy of rituximab maintenance in MRD-negative patients after induction. Omitting or stopping maintenance based on MRD negativity is thus discouraged. Considering the short time to progression, more effective treatment strategies should be explored in MRD-positive patients to improve the long-term prognosis of patients with mantle cell lymphoma,” the study authors concluded.

Patients were assessed for MRD both during and after treatment until clinical disease progression. Baseline samples were taken before the start of treatment, and at least one follow-up sample was obtained from each patient. From these 288 samples, BCL1-JH t(11;14) translocation or IGH rearrangement marker screening and real-time quantitative polymerase chain reaction (PCR) were performed. Patients were classified as MRD-negative if all bone marrow and peripheral blood sample results from a respective time point were negative.

Screening revealed a molecular marker for MRD in 85% of patients, and a satisfactory quantitative PCR assay was produced in 80% of patients. Those treated with rituximab/fludarabine cyclophosphamide who did not have clinical disease progression during induction reached MRD negativity earlier and more frequently than those treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone. At the end of induction, patients with MRD negativity exhibited a clearer efficacy of maintenance (progression-free survival hazard ratio [HR] = 0.38, 95% confidence interval [CI] = 0.21–0.63) than MRD-positive patients (HR = 0.59, 95% CI = 0.28–1.26, interaction P = .097).

Disclosure: For full disclosures of the study authors, visit ash.confex.com.


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