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Horgan D, Walewski J, Aurer I, Visco C, Giné E, Fetica B, Jerkeman M, Kozaric M, da Silva MG, Dreyling M. Tackling Mantle Cell Lymphoma in Europe. Healthcare (Basel) 2022; 10:1682. [PMID: 36141294 PMCID: PMC9498856 DOI: 10.3390/healthcare10091682] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/24/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022] Open
Abstract
An expert panel convened by the European Alliance for Personalized Medicine (EAPM) reflected on achievements and outstanding challenges in Europe in mantle cell lymphoma (MCL). Through the prism of member state experience, the panel noted advances in outcomes over the last decade, but highlighted issues constituting barriers to better care. The list notably included availability of newer treatments, infrastructure and funding for related testing, and shortages of relevant skills and of research support. The prospect of improvements was held to reside in closer coordination and cooperation within and between individual countries, and in changes in policy and scale of investment at both national and EU levels.
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Affiliation(s)
- Denis Horgan
- European Alliance for Personalised Medicine, 1040 Brussels, Belgium
| | - Jan Walewski
- The Maria Sklodowska-Curie National Research Institute of Oncology, 00-001 Warszawa, Poland
| | - Igor Aurer
- Division of Hematology, Department of Internal Medicine, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Carlo Visco
- Department of Medicine, Section of Hematology, University of Verona, 37129 Verona, Italy
| | - Eva Giné
- Instituto Clínic de Enfermedades Hematológicas y Oncológicas, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Bogdan Fetica
- Department of Pathology, Institute of Oncology “Prof. Dr. Ion Chiricuta” Cluj-Napoca, 400015 Cluj-Napoca, Romania
| | - Mats Jerkeman
- Department of Oncology, Institute of Clinical Sciences, Lund University and Skane, University Hospital, BMC F12, 221 84 Lund, Sweden
| | - Marta Kozaric
- European Alliance for Personalised Medicine, 1040 Brussels, Belgium
| | - Maria Gomes da Silva
- Haematology Unit, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, 1099-023 Lisbon, Portugal
| | - Martin Dreyling
- Medical Clinic III, Groβhadern Clinic, Ludwig-Maximilians-Universität, 81377 Munich, Germany
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Genuardi E, Alessandria B, Civita AM, Ferrero S. Targeted Locus Amplification as Marker Screening Approach to Detect Immunoglobulin (IG) Translocations in B-Cell Non-Hodgkin Lymphomas. METHODS IN MOLECULAR BIOLOGY (CLIFTON, N.J.) 2022; 2453:119-132. [PMID: 35622324 DOI: 10.1007/978-1-0716-2115-8_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although MRD monitoring by the classic polymerase chain reaction (PCR) approach is a powerful outcome predictor, about 20% of mantle cell lymphoma (MCL) and 50% of follicular lymphoma (FL) patients still lack a molecular marker and are thus resulting not eligible for MRD monitoring. Targeted locus amplification (TLA), a new NGS technology, has been revealed as a feasible marker screening approach able to identify uncommon B-cell leukemia/lymphoma 1 (BCL1) and B-cell leukemia/lymphoma 2 (BCL2) rearrangements in MCL and FL cases defined as having "no marker" by the classic PCR approach.
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Affiliation(s)
- Elisa Genuardi
- Hematology Division, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Beatrice Alessandria
- Hematology Division, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Aurora Maria Civita
- Hematology Division, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Simone Ferrero
- Hematology Division, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy. .,Hematology Division, AOU "Città della Salute e della Scienza di Torino", Torino, Italy.
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3
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Obiorah IE, Wang HW, Ma D, Martin E, Wilson WH, Braylan R. The Effectiveness of Dual-Staining Immunohistochemistry in the Detection of Mantle Cell Lymphoma in the Bone Marrow. Am J Clin Pathol 2022; 157:709-717. [PMID: 35512254 DOI: 10.1093/ajcp/aqab179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/12/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Immunohistochemistry (IHC) is a useful method for mantle cell lymphoma (MCL) detection in the bone marrow (BM). However, recognition of the neoplastic B cells can be challenging, especially when there is low-level disease. METHODS We examined BM from 105 patients with MCL. IHC was performed using cyclin D1/CD79a and PAX5/CD5 dual stains, which were compared with single stains that included CD20, CD79a, cyclin D1, and CD5 and with multiparameter flow cytometry (FC). RESULTS Based on the FC data, the overall sensitivity of the dual IHC stains was 95.6%. Both dual IHC stains showed better efficacy for detecting MCL cells compared with the aggregated single stains (P = .012). While three cases were positive by FC analysis but negative for dual staining, four cases showed cells positive for cyclin D1/CD79a and PAX5/CD5 dual staining that were not detected by FC. Two of these latter cases were in patients with minimal or focal disease involvement. CONCLUSIONS Cyclin D1/CD79a and PAX5/CD5 dual IHC staining is an efficient procedure for the detection of MCL in the marrow and is particularly helpful in low-level or focal involvement by MCL. This approach can be particularly useful when marrow aspirates are inadequate or unavailable.
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Affiliation(s)
- Ifeyinwa E Obiorah
- Hematopathology Section, Laboratory of Pathology, Bethesda, MD, USA
- Hematology Section, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Hao-Wei Wang
- Hematopathology Section, Laboratory of Pathology, Bethesda, MD, USA
- Flow Cytometry Unit, Laboratory of Pathology, Bethesda, MD, USA
| | - David Ma
- Hematology Section, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Eddie Martin
- Hematology Section, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Wyndham H Wilson
- Lymphoid Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Raul Braylan
- Hematology Section, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Elkjær LAL, Cédile O, Hansen MH, Nielsen C, Møller MB, Abildgaard N, Haaber J, Nyvold CG. Exploration of residual disease in stem cell products from mantle cell lymphoma using next-generation sequencing. Leuk Res Rep 2022; 18:100341. [PMID: 36039182 PMCID: PMC9418493 DOI: 10.1016/j.lrr.2022.100341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 07/01/2022] [Accepted: 08/07/2022] [Indexed: 11/05/2022] Open
Abstract
High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) has become a treatment option for fit patients with mantle cell lymphoma (MCL). However, these patients often relapse within few years, potentially caused by contaminating lymphoma cells within the reinfused stem cell product (SCP). Studies have shown that measurable residual disease, also termed minimal residual disease (MRD), following ASCT predicts shorter survival. Using next-generation sequencing, we explore whether the diagnostic MCL clonotype is present within the infused SCP. MRD was detected in 4/17 of the SCPs, ranging 4–568 clonal cells/100,000 cells. With a median survival of 17 months, 3/4 of patients with MRD+ graft succumbed from MCL relapse versus 2/13 in the MRD– fraction. Patients receiving MRD+ grafts had increased risk of mortality, and thus screening of SCPs may be important for clinical decision-making.
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Quality Assessment for PCR-based Minimal Residual Disease in Lymphoma: 10 Years of Cross-laboratory Standardization Process Within the Fondazione Italiana Linfomi MRD Network. Hemasphere 2021; 5:e639. [PMID: 34514343 PMCID: PMC8423385 DOI: 10.1097/hs9.0000000000000639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/05/2021] [Indexed: 11/26/2022] Open
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Hussaini MO, Srivastava J, Lee LW, Nishihori T, Shah BD, Alsina M, Pinilla-Ibarz J, Shain KH. Assessment of Clonotypic Rearrangements and Minimal Residual Disease in Lymphoid Malignancies: A Large Cancer Center Experience Using clonoSEQ. Arch Pathol Lab Med 2021; 146:485-493. [PMID: 34343238 DOI: 10.5858/arpa.2020-0457-oa] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Measurable (minimal) residual disease (MRD) is an independent prognostic factor for survival outcomes in patients with lymphoid and plasma cell malignancies and has been incorporated into consensus criteria regarding treatment response, strategy, and clinical trial endpoints. clonoSEQ (a next-generation sequencing [NGS]-MRD assay) uses multiplex polymerase chain reaction and NGS to identify clonotypic rearrangements at the immunoglobulin (Ig) H, IgK, IgL, T-cell receptor (TCR)-β, and TCR-γ loci, and translocated B-cell lymphoma 1/IgH and 2/IgH sequences for MRD assessment. Additionally, it can be used to confirm diagnoses of cutaneous T-cell lymphoma (CTCL). OBJECTIVE.— To review the technical aspects of our experience using the clonoSEQ Assay in routine clinical practice. DESIGN.— In this single-center experience, 390 patients with lymphoid and plasma cell malignancies were assessed with the NGS-MRD Assay at a central laboratory. RESULTS.— Median time from arrival of the shipment to initiation of the assay (defined as captured in Adaptive's secure tracking system) was 2.1 hours. Overall, 317 patients had 1 or more samples submitted for sequence identification. Of these, 290 (91.5%) had trackable sequences identified. The median calibration rate of samples by malignancy (where n ≥ 10 samples, excluding CTCL samples) was 88.1%, across a variety of fresh and archived sample sources (177 of 201 samples). TCR-β and/or TCR-γ clonotypes were identified in 40 of 95 samples (42.1%) from 66 patients with suspected CTCL. CONCLUSIONS.— This NGS-MRD Assay is a valuable and sensitive tool for monitoring MRD in patients with plasma cell and lymphoid malignancies and assisting in the diagnosis of CTCL.
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Affiliation(s)
- Mohammad O Hussaini
- From Hematopathology and Laboratory Medicine (Hussaini), Moffitt Cancer Center, Tampa, Florida
| | - Jaya Srivastava
- Medical Affairs, Adaptive Biotechnologies, Seattle, Washington (Srivastava, Lee)
| | - Lik Wee Lee
- Medical Affairs, Adaptive Biotechnologies, Seattle, Washington (Srivastava, Lee)
| | - Taiga Nishihori
- Blood and Bone Marrow Transplantation (Nishihori, Alsina), Moffitt Cancer Center, Tampa, Florida
| | - Bijal D Shah
- Malignant Hematology (Shah, Pinilla-Ibarz, Shain), Moffitt Cancer Center, Tampa, Florida
| | - Melissa Alsina
- Blood and Bone Marrow Transplantation (Nishihori, Alsina), Moffitt Cancer Center, Tampa, Florida
| | - Javier Pinilla-Ibarz
- Malignant Hematology (Shah, Pinilla-Ibarz, Shain), Moffitt Cancer Center, Tampa, Florida
| | - Kenneth H Shain
- Malignant Hematology (Shah, Pinilla-Ibarz, Shain), Moffitt Cancer Center, Tampa, Florida
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Ghosh N, Emond B, Lafeuille MH, Côté-Sergent A, Lefebvre P, Huang Q. Treatment patterns among patients with mantle cell lymphoma and comparison of healthcare resource utilization and costs among relapsed/refractory patients treated with ibrutinib or chemoimmunotherapy: A real-world retrospective study. Clin Ther 2021; 43:1285-1299. [PMID: 34332789 DOI: 10.1016/j.clinthera.2021.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/17/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE This study assessed treatment patterns in patients with mantle cell lymphoma (MCL) and compared health care resource utilization (HRU) and costs of ibrutinib with or without rituximab (I ± R) versus chemoimmunotherapy (CIT) in patients with relapsed/refractory MCL. METHODS For this retrospective cohort study, adults with MCL observed between May 13, 2013, and June 30, 2019, were identified using Optum's de-identified Clinformatics Data Mart Database. Treatment patterns were described among patients who received ≥1 line of therapy (LOT). HRU and costs (payer's perspective) were compared between patients treated with I ± R and CIT in the second or later line (2L+) of therapy. To account for differences in baseline characteristics between the 2 cohorts, inverse probability of treatment weighting was used. Monthly HRU and costs starting from I ± R or CIT treatment initiation (index date) were compared during the first Oncology Care Model (OCM) episode (ie, first 6 months) postindex and during the observed duration of I ± R or CIT LOT (index LOT) using rate ratios (RRs) and mean monthly cost differences (MMCDs), respectively. FINDINGS Among 1346 patients with ≥1 LOT (median follow-up, 15.3 months), 870 (64.6%) were treated with CIT in the first line. Only 348 (25.9%) had a 2L of therapy, of whom 110 (31.6%) were treated with CIT and 98 (28.2%) with an ibrutinib-based therapy. A total of 300 patients were included for the comparison of HRU and costs between 2L+ I ± R and 2L+ CIT. The weighted cohorts (after inverse probability of treatment weighting) included 149 patients treated with I ± R (mean age, 71.6 years; 73.7% men) and 151 treated with CIT (mean age, 71.5 years; 76.2% men). During the first OCM episode and during the index LOT, the I ± R cohort had significantly fewer monthly days with outpatient services compared to the CIT cohort (OCM, RR = 0.63 [P < 0.001]; index LOT, RR = 0.73 [P = 0.004]). Compared to the CIT cohort, the I ± R cohort incurred significantly higher monthly pharmacy costs (MMCDs: OCM, 9938 US dollars [USD] [P < 0.001]; index LOT, 8920 USD [P < 0.001]) that were fully offset by lower monthly medical costs (MMCDs: OCM, -19,373 USD [P < 0.001]; index LOT, -13,548 USD [P < 0.001]), resulting in monthly total health care cost savings (MMCDs, OCM, -9435 USD [P < 0.001]; index LOT , -4628 USD [P = 0.01]). IMPLICATIONS Over a median follow-up of 15.3 months, most patients with MCL were treated with CIT in the first line, and only one fourth had a 2L therapy. Patients with relapsed/refractory MCL treated with I ± R had significantly fewer days with outpatient services and lower monthly total health care costs versus those treated with CIT during the first OCM episode and the index LOT.
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Affiliation(s)
- Nilanjan Ghosh
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Bruno Emond
- Analysis Group Inc, Montreal, Quebec, Canada.
| | | | | | | | - Qing Huang
- Janssen Scientific Affairs LLC, Horsham, Pennsylvania
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Cellular Therapies for Mantle Cell Lymphoma. Transplant Cell Ther 2021; 27:363-370. [PMID: 33965173 DOI: 10.1016/j.jtct.2021.01.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/15/2021] [Accepted: 01/31/2021] [Indexed: 11/24/2022]
Abstract
Mantle cell lymphoma (MCL) is a subtype of B cell non-Hodgkin lymphoma characterized by a heterogeneous clinical presentation. Patients who demonstrate an objective response to induction therapy(ies) and are eligible for intensive therapies are offered an autologous hematopoietic cell transplant (HCT) as front-line consolidation followed by rituximab maintenance. Allogeneic HCT is an option for younger and fit patients with high-risk disease or in patients who have relapsed after autologous HCT. Recent advances in T cell engineering brought chimeric antigen receptor T cell (CAR T) therapy from the bench to the bedside, with brexucabtagene autoleucel being the first CAR T product approved by the US Food and Drug Administration for use in relapsed/refractory MCL. In this comprehensive review, we summarize the literature on available cellular therapies for MCL and present a treatment algorithm that incorporates HCT, autologous or allogeneic, and CAR T therapies.
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9
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Kambhampati S, Hunter B, Varnavski A, Fakhri B, Kaplan L, Ai WZ, Pampaloni M, Huang CY, Martin T, Damon L, Andreadis CB. Ofatumumab, Etoposide, and Cytarabine Intensive Mobilization Regimen in Patients with High-risk Relapsed/Refractory Diffuse Large B-Cell Lymphoma Undergoing Autologous Stem Cell Transplantation. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:246-256.e2. [PMID: 33288485 DOI: 10.1016/j.clml.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND More than one-half of high-risk patients with relapsed/refractory (rr) diffuse large B-cell lymphoma (DLBCL) relapse after autologous hematopoietic cell transplantation (auto-HCT). In this phase II study, we investigate the long-term outcomes of high-risk patients with rrDLBCL receiving intensive consolidation therapy (ICT) with OVA (ofatumumab, etoposide, and high-dose cytarabine) prior to auto-HCT. PATIENTS AND METHODS The primary endpoints were the ability of OVA to mobilize peripheral stem cells and the 2-year progression-free survival (PFS) rate following OVA. Secondary endpoints included safety, 2-year overall survival (OS), impact of cell of origin (COO), and the prognostic utility of next-generation sequencing minimal residual disease (MRD) testing. We simultaneously retrospectively assessed the outcomes of DLBCL patients who underwent ICT with a similar regimen at our institution. RESULTS Twenty-seven patients received salvage chemotherapy, with a response rate of 25% in patients with germinal center B-cell (GCB)-DLBCL versus 92% in patients with non-GCB-DLBCL (P = .003). Nineteen responding patients underwent ICT with OVA (100% successful stem cell mobilization). The 2-year PFS and OS rate was 47% and 59%, respectively, with no difference based on COO. Similar findings were observed when the study and retrospective cohorts were combined. Neutropenia was the most common toxicity (47%). MRD-negative patients at the completion of salvage had a median OS of not reached versus 3.5 months in MRD-positive patients (P = .02). CONCLUSIONS OVA followed by auto-HCT is effective and safe for high-risk rrDLBCL. Patients with GCB-DLBCL had a lower response to salvage chemotherapy, but no difference in outcomes based on COO was seen after auto-HCT. MRD testing in the relapsed setting was predictive of long-term survival.
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MESH Headings
- Adult
- Aged
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Cytarabine/administration & dosage
- Cytarabine/adverse effects
- Drug Resistance, Neoplasm
- Etoposide/administration & dosage
- Etoposide/adverse effects
- Female
- Germinal Center/pathology
- Hematopoietic Stem Cell Transplantation
- Humans
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/therapy
- Neoplasm, Residual
- Prognosis
- Progression-Free Survival
- Retrospective Studies
- Salvage Therapy/adverse effects
- Salvage Therapy/methods
- Survival Rate
- Transplantation, Autologous/methods
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Affiliation(s)
- Swetha Kambhampati
- Division of Hematology/Oncology, Department of Medicine, UCSF Medical Center, San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, UCSF Medical Center, San Francisco, CA
| | - Bradley Hunter
- Department of Hematology, Intermountain Healthcare, Salt Lake City, UT
| | | | - Bita Fakhri
- Division of Hematology/Oncology, Department of Medicine, UCSF Medical Center, San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, UCSF Medical Center, San Francisco, CA
| | - Lawrence Kaplan
- Division of Hematology/Oncology, Department of Medicine, UCSF Medical Center, San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, UCSF Medical Center, San Francisco, CA
| | - Weiyun Z Ai
- Division of Hematology/Oncology, Department of Medicine, UCSF Medical Center, San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, UCSF Medical Center, San Francisco, CA
| | | | - Chiung-Yu Huang
- UCSF Helen Diller Family Comprehensive Cancer Center, UCSF Medical Center, San Francisco, CA; Department of Epidemiology and Biostatistics, UCSF Medical Center, San Francisco, CA
| | - Thomas Martin
- Division of Hematology/Oncology, Department of Medicine, UCSF Medical Center, San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, UCSF Medical Center, San Francisco, CA
| | - Lloyd Damon
- Division of Hematology/Oncology, Department of Medicine, UCSF Medical Center, San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, UCSF Medical Center, San Francisco, CA
| | - Charalambos B Andreadis
- Division of Hematology/Oncology, Department of Medicine, UCSF Medical Center, San Francisco, CA; UCSF Helen Diller Family Comprehensive Cancer Center, UCSF Medical Center, San Francisco, CA.
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Jung D, Jain P, Yao Y, Wang M. Advances in the assessment of minimal residual disease in mantle cell lymphoma. J Hematol Oncol 2020; 13:127. [PMID: 32972438 PMCID: PMC7513535 DOI: 10.1186/s13045-020-00961-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/03/2020] [Indexed: 12/15/2022] Open
Abstract
The clinical impact of minimal residual disease detection at early time points or during follow-ups has been shown to accurately predict relapses among patients with lymphomas, mainly in follicular and diffuse large B cell lymphoma. The field of minimal residual disease testing in mantle cell lymphoma is still evolving but has great impact in determining the prognosis. Flow cytometry and polymerase chain reaction-based testing are most commonly used methods in practice; however, these methods are not sensitive enough to detect the dynamic changes that underline lymphoma progression. Newer methods using next-generation sequencing, such as ClonoSeq, are being incorporated in clinical trials. Other techniques under evolution include CAPP-seq and anchored multiplex polymerase chain reaction-based methods. This review article aims to provide a comprehensive update on the status of minimal residual disease detection and its prognostic effect in mantle cell patients. The role of circulating tumor DNA-based minimal residual disease detection in lymphomas is also discussed.
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Affiliation(s)
- Dayoung Jung
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Preetesh Jain
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.,Department of Hemapathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Yixin Yao
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Michael Wang
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
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Buege MJ, Kumar A, Dixon BN, Tang LA, Pak T, Orozco J, Peterson TJ, Maples KT. Management of Mantle Cell Lymphoma in the Era of Novel Oral Agents. Ann Pharmacother 2020; 54:879-898. [PMID: 32079411 PMCID: PMC8330616 DOI: 10.1177/1060028020909117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objectives: To discuss (1) recent and emerging data for pharmacological management of untreated and relapsed/refractory (R/R) mantle cell lymphoma (MCL) with agents approved in the United States, (2) important considerations for toxicity monitoring and management, and (3) preliminary data and ongoing studies for agents in MCL-specific clinical trials. Data Sources: PubMed/MEDLINE, EMBASE, Google Scholar, product labeling, National Comprehensive Cancer Network, American Cancer Society, and ClinicalTrials.gov were searched for studies published between January 1, 2017, and January 31, 2020, and key historical trials. Study Selection and Data Extraction: Relevant studies conducted in humans and selected supporting preclinical data were reviewed. Data Synthesis: MCL is a rare but usually aggressive non-Hodgkin lymphoma that most commonly affects the older population. Traditionally, the treatment of MCL has been determined based on transplant eligibility. Newer data suggest that more tolerable frontline therapy may produce outcomes similar to intensive historical induction regimens, possibly precluding fewer patients from autologous stem cell transplant and producing better long-term outcomes in transplant-ineligible patients. In the R/R setting, novel regimens are improving outcomes and changing the landscape of treatment. Relevance to Patient Care and Clinical Practice: This review summarizes and discusses recent and emerging data for management of newly diagnosed and R/R MCL; key supportive care considerations for agents are also discussed. Conclusions: Recent study results are changing management of MCL. Although these data have complicated the picture of regimen selection, increasingly effective and tolerable therapy and additional anticipated data point to a brighter future for patients with MCL.
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Affiliation(s)
| | - Anita Kumar
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Laura A Tang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Terry Pak
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Tim J Peterson
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Minimal Residual Disease in Mantle Cell Lymphoma: Methods and Clinical Significance. Hematol Oncol Clin North Am 2020; 34:887-901. [PMID: 32861285 DOI: 10.1016/j.hoc.2020.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Several biological and clinical features have been recognized in mantle cell lymphoma (MCL). In recent years, the minimal residual disease (MRD) has been extensively investigated and is now considered as one of the strongest clinical predictors in this lymphoma. This article reviews methods used for the assessment of MRD in MCL and discusses their strengths and weaknesses. In addition, it examines the MRD contribution to the biology knowledge of MCL and the development of effective strategies for its management, including the possibility of personalized treatment based on MRD response.
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Abstract
PURPOSE OF REVIEW Mantle cell lymphoma is a CD5+ non-Hodgkin lymphoma associated with suboptimal outcome. Young, fit patients are generally offered intensive induction followed by autologous hematopoietic cell transplantation (AHCT) in first remission. Some patients may not benefit from this strategy. RECENT FINDINGS Recent studies have investigated the role of AHCT in the modern era. First, an analysis of the National Cancer Database demonstrated improved progression-free survival (PFS) for consolidative AHCT. Second, a multi-center study associated consolidative AHCT with improved PFS even after propensity-weighted analysis. Improved overall survival (OS) for certain subgroups was suggested. Third, patients with p53 mutations derive little benefit from AHCT. Finally, retrospective series suggest certain high-risk patients may be considered for allogenic HCT. AHCT consolidation in first remission is associated with improved PFS even after adjustment for disease severity. An overall survival benefit has not been definitively shown. Patients with p53 mutations should be treated with novel agents.
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Smolewski P, Rydygier D, Robak T. Clinical management of mantle cell lymphoma in the elderly. Expert Opin Pharmacother 2019; 20:1893-1905. [PMID: 31373238 DOI: 10.1080/14656566.2019.1642871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Introduction: Mantle cell lymphoma (MCL) is a disease with an indolent histology, but mostly aggressive clinical course. While treatment can yield more promising results in younger patients, the disease is most diagnosed at a median age of approximately 70 years, and treatment in this group still presents a major challenge for oncohematologists. Unfortunately, due to comorbidities and poorer general status, the implementation of intensive treatment approaches with the cytarabine-based regimens and autologous stem cell transplantation is generally not possible, and the disease remains incurable, especially in elderly patients. Areas covered: In this paper, the authors discuss the therapeutic options available for older patients with MCL in the first line and relapsed/refractory settings, indicating new therapeutic options, which may achieve longer remissions and overall survival. Expert opinion: Although great progress has been made in the treatment of MCL in recent years, there remains a need for new treatment lines which can allow improved patient outcomes. Novel agents targeting altered the signal transduction pathways in MCL cells may offer more promise than traditional chemotherapy or immunochemotherapy and are currently being tested in clinical trials.
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Affiliation(s)
- Piotr Smolewski
- Department of Experimental Hematology, Medical University of Lodz , Lodz , Poland
| | - Dominika Rydygier
- Department of Hematology, Medical University of Lodz , Lodz , Poland
| | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz , Lodz , Poland
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Tang C, Kuruvilla J. Optimal management of mantle cell lymphoma in the primary setting. Expert Rev Hematol 2019; 12:715-721. [PMID: 31268728 DOI: 10.1080/17474086.2019.1639501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: The management of mantle cell lymphoma (MCL) has significantly improved since the use of intensified induction and autologous stem cell transplant consolidation. Evolving developments in minimal residual disease detection and novel agent therapy are now challenging this frontline treatment paradigm. Areas covered: This review discusses both the established role of induction and transplant consolidation in MCL, followed by evolving concepts in the use of novel agents in the frontline setting, and the use of minimal residual disease as a driver of MCL management. Expert opinion: In an era of novel agents and improved biologic understanding of MCL, our goal for frontline management should evolve toward personalized therapy for individual patients to maximize efficacy and survival whilst minimizing treatment-related toxicities.
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Affiliation(s)
- Catherine Tang
- Division of Medical Oncology & Hematology, Princess Margaret Hospital , Toronto , Canada.,Department of Medicine, University of Toronto , Toronto , Canada
| | - John Kuruvilla
- Division of Medical Oncology & Hematology, Princess Margaret Hospital , Toronto , Canada.,Department of Medicine, University of Toronto , Toronto , Canada
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Jain P, Wang M. Mantle cell lymphoma: 2019 update on the diagnosis, pathogenesis, prognostication, and management. Am J Hematol 2019; 94:710-725. [PMID: 30963600 DOI: 10.1002/ajh.25487] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/04/2019] [Accepted: 04/04/2019] [Indexed: 12/16/2022]
Abstract
Unprecedented advances in our understanding of the pathobiology, prognostication, and therapeutic options in mantle cell lymphoma (MCL) have taken place in the last few years. Heterogeneity in the clinical course of MCL-indolent vs aggressive-is further delineated by a correlation with the mutational status of the variable region of immunoglobulin heavy chain, methylation status, and SOX-11 expression. Cyclin-D1 negative MCL, in situ MCL neoplasia, and impact of the karyotype on prognosis are distinguished. Apart from Ki-67% and morphology pattern (classic vs blastoid/pleomorphic), the proliferation gene signature has helped to further refine prognostication. Studies focusing on mutational dynamics and clonal evolution on Bruton's tyrosine kinase (BTK) inhibitors (ibrutinib, acalabrutinib) and/or Bcl2 antagonists (venetoclax) have further clarified the prognostic impact of somatic mutations in TP53, BIRC3, CDKN2A, MAP3K14, NOTCH2, NSD2, and SMARCA4 genes. In therapy, long-term follow-up on chemo-immunotherapy studies has demonstrated durable remissions in some patients; however, long-term toxicities, especially from second cancers, are a serious concern with chemotherapy. The therapeutic options in MCL are constantly evolving, with dramatic responses from nonchemotherapeutic agents (ibrutinib, acalabrutinib, and venetoclax). Chimeric antigen receptor therapy and combinations of nonchemotherapeutic agents are actively being studied and our focus is shifting toward making the treatment of MCL chemotherapy-free. Still, MCL remains incurable. The following aspects of MCL continue to pose a challenge: disease transformation, role of the cytokine-microenvironmental milieu, incorporation of positron emission tomography-computerized tomography imaging, minimal residual disease in the prognosis, circulating tumor DNA testing for clonal evolution, predicting resistance to BTK inhibitors, and optimal management of patients who progress on BTK/Bcl2 inhibitors. Next-generation clinical trials should incorporate nonchemotherapeutic agents and personalize the treatment based upon the genomic profile of individual patient. Recent advances in the field of MCL are reviewed.
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Affiliation(s)
- Preetesh Jain
- Division of Cancer Medicine, Department of Lymphoma/MyelomaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Michael Wang
- Division of Cancer Medicine, Department of Lymphoma/MyelomaThe University of Texas MD Anderson Cancer Center Houston Texas
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Kahl BS, Dreyling M, Gordon LI, Martin P, Quintanilla-Martinez L, Sotomayor EM. Recent advances and future directions in mantle cell lymphoma research: report of the 2018 mantle cell lymphoma consortium workshop. Leuk Lymphoma 2019; 60:1853-1865. [PMID: 30696305 DOI: 10.1080/10428194.2019.1571205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Mantle cell lymphoma (MCL) is an aggressive B-cell non-Hodgkin lymphoma characterized by the t(11;14) chromosomal translocation. This translocation most often results in overexpression of cyclin D1. MCL is clinically heterogeneous, outcomes are generally poor, and no standard treatment has been established. The recent approvals of ibrutinib and acalabrutinib have provided an additional therapeutic option; however, resistance has emerged as a significant issue and presents the need for more detailed studies of resistance mechanisms. Recent clinical trials have provided new perspectives on the relative efficacy and safety of various approaches for both transplant-eligible and transplant-ineligible patients. Multiple novel strategies are being evaluated in the treatment of MCL, including both targeted agents and cellular immunotherapies. At the Lymphoma Research Foundation's 13th MCL Workshop, researchers gathered to discuss research findings, clinical trial results, and future directions related to MCL, its biology, and its treatment. This report, which includes a summary of each presentation, aims to review recent findings in MCL research and highlight potential areas for future study.
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Affiliation(s)
- Brad S Kahl
- a Washington University School of Medicine , St. Louis , MO , USA
| | - Martin Dreyling
- b Department of Medicine III , University Hospital, LMU Munich , Munchen , Germany
| | - Leo I Gordon
- c Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Peter Martin
- d Weill Cornell Medicine Division of Hematology-Oncology , New York , NY , USA
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Agarwal R, Chan YC, Tam CS, Hunter T, Vassiliadis D, Teh CE, Thijssen R, Yeh P, Wong SQ, Ftouni S, Lam EYN, Anderson MA, Pott C, Gilan O, Bell CC, Knezevic K, Blombery P, Rayeroux K, Zordan A, Li J, Huang DCS, Wall M, Seymour JF, Gray DHD, Roberts AW, Dawson MA, Dawson SJ. Dynamic molecular monitoring reveals that SWI–SNF mutations mediate resistance to ibrutinib plus venetoclax in mantle cell lymphoma. Nat Med 2018; 25:119-129. [DOI: 10.1038/s41591-018-0243-z] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 09/21/2018] [Indexed: 11/09/2022]
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Evolving treatment strategies in mantle cell lymphoma. Best Pract Res Clin Haematol 2018; 31:270-278. [PMID: 30213396 DOI: 10.1016/j.beha.2018.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 07/06/2018] [Indexed: 12/23/2022]
Abstract
Mantle cell lymphoma is an incurable, moderately aggressive B cell lymphoma. While a small proportion of patients with indolent disease can be managed expectantly, most patients require treatment. The therapeutic approach is driven by physician recommendation, patient choice, age, fitness and comorbidities. Young, fit patients often receive combination chemoimmunotherapy, including high dose cytarabine, with autologous stem cell transplant. Recent data has indicated benefit from maintenance rituximab following autologous stem cell transplant. Ongoing trials are investigating combinations of chemotherapy and targeted agents as well as the role of minimal residual disease guided therapy. Older, less fit patients often receive bendamustine and rituximab or anthracycline based regimens. Maintenance rituximab is typically administered in older MCL patients after anthracycline based chemotherapy although its use after bendamustine based therapy is not supported by current data. Current trials focus on refining this regimen with the addition of targeted agents. In the relapsed and refractory setting, novel agents have demonstrated activity although durability of responses remains unsatisfactory.
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