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

2009; Elsevier BV; Volume: 115; Issue: 16 Linguagem: Inglês

10.1182/blood-2009-06-230250

1528-0020

Christiane Pott, Eva Hoster, Marie‐Hélène Delfau‐Larue, Kheïra Beldjord, Sebastian Böttcher, Vahid Asnafi, Anne Plonquet, Reiner Siebert, Evelyne Callet‐Bauchu, Niels Smedegaard Andersen, Jacques J. M. van Dongen, Wolfram Klapper, Françoise Berger, Vincent Ribrag, Achiel L. van Hoof, Marek Trněný, Jan Walewski, Peter Dreger, Michael Unterhalt, Wolfgang Hiddemann, Michael Kneba, Hanneke C. Kluin‐Nelemans, Olivier Hermine, Elizabeth Macintyre, Martin Dreyling,

Chronic Lymphocytic Leukemia Research

Abstract 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.