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

Blood. 2010 Apr 22;115(16):3215-23. doi: 10.1182/blood-2009-06-230250. Epub 2009 Dec 23.


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 as #NCT00209222 and #NCT00209209.

Keywords: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Cell Separation; Combined Modality Therapy; Female; Flow Cytometry; Humans; Immunohistochemistry; Immunotherapy; Lymphoma, Mantle-Cell; MRD; Male; Middle Aged; Neoplasm Staging; Neoplasm, Residual; Polymerase Chain Reaction; Prognosis; RQ-PCR; Radiotherapy; Treatment Outcome; autologous stem cell transplantation; immunochemotherapy; mantle cell lymphoma; methods; minimal residual disease; pathology; therapeutic use; therapy.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols* / therapeutic use
  • Cell Separation
  • Combined Modality Therapy
  • Female
  • Flow Cytometry
  • Humans
  • Immunohistochemistry
  • Immunotherapy* / methods
  • Lymphoma, Mantle-Cell / pathology*
  • Lymphoma, Mantle-Cell / therapy*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Neoplasm, Residual
  • Polymerase Chain Reaction
  • Prognosis
  • Radiotherapy*
  • Treatment Outcome

Associated data