Transcript
Hi, I'm Kami Maddocks, associate professor of clinical internal medicine at Ohio State University here at Great Debates in Hematology where I'll be talking about what's current in new approaches to the treatment of mantle cell lymphoma.
Historically, the treatment of mantle cell lymphoma has been approached from looking at patient age and comorbidities. Younger, healthy patients are often given aggressive therapy and taken to autologous stem cell transplant. Older patients are given chemotherapy with possibly rituximab maintenance after treatment.
There are 2 large studies in the United States ongoing in front-line approach, and one in Europe looking at both the role of transplant in patients who achieve MRD-negative status and the role of BTK inhibitors.
There's a large randomized trial in the US looking at the front-line approach to mantle cell lymphoma to achieve a high rate of MRD negativity. That looks at incorporating the BTK inhibitor acalabrutinib into the regimen with BR and high-dose cytarabine.
The second large randomized US trial is looking at taking all patients, regardless of their initial therapy, who achieve a minimal residual disease negative state, and randomizing them to transplant or rituximab maintenance, as it is unclear if patients who achieve MRD negativity really benefit from the transplant. They may not need this aggressive of an approach.
There's also a large randomized trial in Europe ongoing that's looking at RCHOP, RDHAP, plus or minus the BTK inhibitor ibrutinib, followed by ibrutinib maintenance versus transplant. That is to evaluate both the role of the BTK inhibitor ibrutinib in the front-line treatment and the role of transplant when we use these novel agents in the front-line therapy.
Additionally, given the toxicities of chemotherapy and the high activity of oral agents at relapse, including the BTK inhibitors ibrutinib, acalabrutinib, zanubrutinib, the BCL-2 inhibitor venetoclax, and a small trial showing excellent responses in front-line therapy with patients receiving rituximab and lenalidomide, there's a lot of ongoing trials looking at different combinations of a non-chemotherapeutic approach in order to reduce toxicities.
There's trials looking at combinations of rituximab/acalabrutinib/lenalidomide, rituximab/ibrutinib/lenalidomide, rituximab/acalabrutinib/venetoclax, and rituximab/venetoclax/lenalidomide. All exciting trials in patients using a non-chemotherapeutic approach.
