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Stratification Schemes Guide Treatment Decisions in MCL

Caroline Seymour
Published: Monday, Mar 18, 2019

Andre Goy, MD
Andre Goy, MD
Deciding which therapy to pursue for a patient with mantle cell lymphoma (MCL) is dependent on 3 criteria, explained Andre Goy, MD, MS. Specifically, whether a patient’s disease is indolent or symptomatic, their age and fitness, and the presence of certain high-grade molecular markers.

, Goy, chief, Division of Lymphoma, chairman and director, John Theurer Cancer Center, shared further insight on the stratification of patients with MCL and other molecular markers that are being applied towards optimal treatment decisions in this disease.

OncLive: Could you discuss the treatment options for patients with MCL?

Goy: Approximately 5% to 15% of patients have indolent disease. These are asymptomatic patients who have a high white count, splenomegaly, and minimal lymphadenopathy, if any. These patients can be monitored over time. Sometimes, these patients can acquire a p53 abnormality, [in which the disease] can transform aggressively. It's rare, but it can happen. These patients can be monitored and not treated early on.

The last aspect that's important in MCL is achieving minimal residual disease (MRD) negativity, as it really translates into better outcomes. It might be able to guide maintenance therapy in the future. This is a really exciting time in MCL. There's a shift towards identifying the subset of high-risk patients who should receive frontline biological therapy and then chemotherapy, the patients who are frail and can’t get chemotherapy, and the rest who can receive different treatment based on their stratification.

What remain the biggest challenges in the field?

There are still a number of challenges that we face, one of which is that the median age at diagnosis is the mid- to late-60s. That makes intensive chemotherapy difficult. We still don't know if high-dose therapy and autologous transplant is beneficial after induction therapy, particularly in patients who are MRD negative. Achieving a deep complete remission and MRD early in MCL matters.

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