MRD Status Predicts Efficacy of Rituximab Maintenance Among Elderly Patients With MCL

Findings from the European Mantle Cell Lymphoma Elderly Trial

Minimal residual disease (MRD) status held value in predicting the efficacy of rituximab maintenance among elderly patients (aged 60 and older) with previously untreated mantle cell lymphoma (MCL), demonstrating the efficacy of rituximab maintenance for patients who are MRD-negative after induction, according to findings from the European Mantle Cell Lymphoma Elderly Trial published in the Journal of Clinical Oncology. 

Eva Hoster, PhD, LMU Munich, Munich, Germany, and coauthors stated, “The outcome of older patients with mantle cell lymphoma has improved by the introduction of immunochemotherapy, followed by rituximab (R)-maintenance.”
        
In this trial, the study authors aimed to assess the potential prognostic value of MRD on the efficacy of rituximab maintenance among elderly patients in order to influence individualized treatment plans and consolidation strategies. Patients with previously untreated MCL aged 60 years and older were included in this trial and randomly assigned to receive rituximab maintenance after response to rituximab, fludarabine, cyclophosphamide (R-FC) or rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP). Through real-time quantitative polymerase chain reaction (qPCR), MRD was monitored. 

According to study results, 80% of a total of 288 patients were able to be assessed by the qPCR with a median sensitivity of 1 × 10−5. The efficacy of rituximab maintenance in clinical remission was confirmed among patients with MRD negativity at the end of induction, with regard to progression-free survival and overall survival, for patients who received R-CHOP, in particular. 

Rituximab maintenance was determined to be less efficacious among patients with MRD positivity, both overall and post-R-CHOP induction. Patients who received R-FC were able to experience more frequent and faster MRD clearance than those who received R-CHOP. In clinical remission after induction, MRD-positivity was correlated with a short median time to clinical progression, which was about 1 to 1.7 years. Based on the study outcomes, MRD status was able to predict the efficacy trends of rituximab maintenance among elderly patients with MCL. 

Hoster and the study authors concluded, “The results confirm the strong efficacy of R-maintenance in patients who are MRD-negative after induction. Treatment de-escalation for MRD-negative patients is discouraged by our results.”

“More effective consolidation strategies should be explored in MRD-positive patients to improve their long-term prognosis,” they added. 

Source: 

Hoster E, Delfau-Larue MH, Macintyre E, et al. Predictive value of minimal residual disease for efficacy of rituximab maintenance in mantle cell lymphoma: results from the European mantle cell lymphoma elderly trial. J Clin Oncol. Published online: November 22, 2023. doi:10.1200/JCO.23.00899