Christian Winther Eskelund, MD
Mantle cell lymphoma (MCL) remains a poor prognosis disease, though strides are being made in treatment for younger populations of patients.
Investigators are trying to better understand this heterogeneous disease, specifically by analyzing samples from the Nordic MCL2 and MCL3 trials, which showed TP53
mutations are associated with poor outcomes.
Deletions of TP53
have shown to confer a negative impact as well. This lead to an analysis which aimed to describe the prevalence and impact of TP53
deletions in DNA samples from MCL2 and MCL3 in the context of TP53
Findings validated previous reports of poor outcome associated with both TP53
deletions of young patients with MCL. After a median follow-up of 9.2 years, median overall survival was 12.4 years and progression-free survival was 8.2 years for all patients.
More importantly though, investigators noted, is that TP53
mutations have an independent prognostic value in MCL. Meaning, TP53
mutations have a role as a biomarker for response to standard-of-care immune-chemotherapy.
In an interview with OncLive at the 2017 European Hematology Association Congress, Christian Winther Eskelund, MD, Copenhagen University Hospital, Rigshospitalet, discussed TP53
mutations in MCL.
Could you provide some background on this research?
Mantle cell lymphoma is a pretty rare lymphoma and has been associated with a very poor outcome. From 2000 to 2005, the Nordic MCL2 trial was conducted and showed pretty good results. During that trial, DNA was taken from patients enrolled—which is the biobank that I used for my study. Basically, we wanted to explore genetic aberrations and see if any cells were associated with poor or better outcomes. The results showed the TP53
was the main interest.
We looked for point mutations and small indoles by next-generation sequencing. We used a targeted panel consisting of 8 genes that have been shown to be recurrently mutated in MCL. We checked for 2 other markers of deletions of larger regions of TP53
and another gene called CDKN2A
What were the significant findings?
Patients who had TP53
mutations did far worse than patients who were unmutated. We showed median overall survival of patients with TP53
mutations of only 1.8 years versus the median OS of unmutated patients were above 12 years. It is a pretty big difference and outweighed all of the other known prognostic markers in MCL.
It wasn't so surprising though, TP53
is normally associated with poor outcome in most cancers, but especially hematologic cancers. We were surprised that even though treatment works so well in younger patients with MCL, still TP53
mutated patients do so poorly.
How do these findings impact the treatment landscape of MCL?
Understandably, people need to feel certain that this information is valid—but we are not the only ones showing this. TP53
has been associated with poor outcomes in MCL in different cohorts. We have now validated these findings in younger patients who are treated by what is currently the standard of care in MCL.
What we think the data suggests is that you should measure TP53
mutational status upfront when you diagnose a patient with MCL, and then, if there are any experimental trials, to include patients with TP53
-mutated MCL. So far, they aren’t around, but there is a big European study called the Triangle trial that has 2 arms that include ibrutinib (Imbruvica), which has [has shown a] better effect, at least in patients with CLL with TP53
mutations. So, that is a potential option.
What would you like community oncologists to take away from these findings?
The main message is that TP53
mutations are associated with very poor outcomes in MCL, even though patients are treated very heavily with chemotherapy. We need to see if we can do something else with these patients, or even upfront treatment with allogeneic transplant.
Are there any other significant developments in MCL you would like to highlight?
There are more clinical trials in MCL, and of course trials including novel drugs—which, in light of these mutations, I am excited to see if they have a better effect there. But so far, I don’t think people are stratifying for TP53.