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%) achi...

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Published in:Blood 2010-04, Vol.115 (16), p.3215-3223
Main Authors: Pott, Christiane, Hoster, Eva, Delfau-Larue, Marie-Helene, Beldjord, Kheira, Böttcher, Sebastian, Asnafi, Vahid, Plonquet, Anne, Siebert, Reiner, Callet-Bauchu, Evelyne, Andersen, Niels, van Dongen, Jacques J.M., Klapper, Wolfram, Berger, Françoise, Ribrag, Vincent, van Hoof, Achiel L., Trneny, Marek, Walewski, Jan, Dreger, Peter, Unterhalt, Michael, Hiddemann, Wolfgang, Kneba, Michael, Kluin-Nelemans, Hanneke C., Hermine, Olivier, Macintyre, Elizabeth, Dreyling, Martin
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Biological and medical sciences
Cell Separation
Combined Modality Therapy
Female
Flow Cytometry
Hematologic and hematopoietic diseases
Humans
Immunohistochemistry
Immunotherapy - methods
Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis
Lymphoma, Mantle-Cell - pathology
Lymphoma, Mantle-Cell - therapy
Male
Medical sciences
Middle Aged
Neoplasm Staging
Neoplasm, Residual
Polymerase Chain Reaction
Prognosis
Radiotherapy
Treatment Outcome
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Summary: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.
ISSN:0006-4971
1528-0020
DOI:10.1182/blood-2009-06-230250