Molecular remission is an independent predictor of clinical outcome in patients with mantle cell lymphoma after combined immunochemotherapy: a European MCL intergroup study

摘要

The prognostic impact of minimal residual disease (MRD) was analyzed in 259 patients with mantle cell lymphoma (MCL) treated within two randomized trials of the European MCL Network (MCL Younger and MCL Elderly trial). After rituximab-based induction treatment 106/190 evaluable patients (56%) achieved a molecular remission (MR) based upon 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=0.0043) and emerged to be an independent prognostic factor for RD (HR 0.4, 95% CI 0.1–0.9, p=0.027). MR was highly predictive for prolonged RD independent of clinical response (CR, CRu, PR) (RD at 2 years: 100% in BM MRD-negative CR and 88% in BM MRD-negative CRu/PR, compared to 78% in BM MRD-positive CR and 53% in BM MRD-positive CRu/PR, p=0.0015). Sustained MR during the post-induction period was predictive for outcome in MCL Younger after ASCT (RD at 2 years 100% vs. 65%, p=0.0007) and during maintenance in MCL Elderly (RD at 2 years: 76% vs. 36%, p=0.015). ASCT in MCL Younger patients increased the proportion of patients in MR from 55% prior to high dose therapy to 72% thereafter. Sequential MRD monitoring is a powerful predictor for treatment outcome in MCL.