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Jeremy S. Abramson, MD, MMSc
Jeremy S. Abramson, MD, MMSc
Posted: Tuesday, January 21, 2025
Timothy S. Fenske, MD, of the Medical College of Wisconsin, Milwaukee, and colleagues evaluated whether autologous hematopoietic stem cell transplantation (ASCT) could improve outcomes among patients with mantle cell lymphoma who achieved deep first remission. Presented during the 2024 American Society of Hematology (ASH) Annual Meeting & Exposition (Abstract LBA-6), the initial report from the ECOG-ACRIN EA4151 trial suggests that longer follow-up is needed to evaluate the true impact of ASCT in these patients.
“In this interim analysis, mantle cell lymphoma patients in first complete remission with undetectable measurable residual disease (MRD) at 1 in 10-6 sensitivity (undetectable MRD6) did not benefit from consolidative ASCT,” concluded the investigators. “Patients who remain MRD-positive after induction may benefit from ASCT.”
This phase III trial enrolled 650 patients with mantle cell lymphoma who were in first remission. Individuals in complete remission with undetectable MRD were randomly assigned 1:1 to receive 3 years of maintenance rituximab (arm A) with or without ASCT (arm B), and those who were MRD-positive (arm C) or MRD-indeterminate (arm D) received the former regimen.
The median follow-up was 2.7 years, and the estimated overall survival hazard ratio among patients in complete remission with undetectable MRD crossed the futility boundary of 0.984. The 3-year overall survival rates in arms A and B were 82.1% and 82.7%, respectively; the 3-year progression-free survival rates were 76.6% and 77.4%, respectively. The 3-year overall survival rate in the intensive induction group was higher in arm B than arm A (86.2% vs 83.0%), although the opposite was true for the nonintensive induction group (72.8% vs 79.5%). Overall survival and progression-free survival in arms C (81.9% and 76.9%) and D (85.1% and 73.4%) were also similar. Of note, patients who converted to undetectable MRD6 from MRD-positive after ASCT demonstrated better overall and progression-free survival than those who remained MRD-positive.
Disclosure: For full disclosures of the study authors, visit ash.confex.com.
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