Can We Omit Auto-SCT in Patients With Mantle Cell Lymphoma With Undetectable MRD Post-Induction?

Jan 06, 2025

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Autologous hematopoietic stem cell transplantation (auto-SCT) did not improve the outcomes of patients with mantle cell lymphoma who had undetectable minimal residual disease (MRD) after induction therapy, indicating that auto-SCT may be redundant in this era of highly effective induction and maintenance therapies.

The phase 3 ECOG-ACRIN EA4151 study (NCT03267433) included 650 patients with mantle cell lymphoma who received an ‘any induction’ regimen and were then tested for clonal markers. Patients who did not have informative markers, defined as ‘MRD indeterminate’, (n=85) and those who were MRD-positive (n=49) were all allocated to receive auto-SCT plus rituximab. Patients with undetectable MRD were randomly assigned 1:1 to auto-SCT plus rituximab (arm A, n=257) or rituximab alone (arm B, n=259). The primary outcome was overall survival (OS).

The 3-year OS rates were 82.1% for arm A and 82.7% for arm B (HR 1.11; 95% CI 0.71–1.74; P=0.66), showing that there was no benefit of auto-SCT in patients with mantle cell lymphoma who achieved undetectable MRD after induction therapy. This finding was consistent across Mantle cell lymphoma International Prognostic Index (MIPI) risk groups regardless of whether patients had received intensive or non-intensive induction therapy.

“Although the numbers were small, an exploratory analysis displayed that MRD-positive patients who converted to undetectable MRD after auto-SCT (n=17) had better overall survival than those who remained MRD-positive after auto-SCT (OS rate 100% vs 63.6%). This suggests that auto-SCT still has value in patients who are MRD-positive after induction therapy,” argued Timothy Fenske, MD, from the Medical College of Wisconsin.

“The initial findings of the EA4151 trial indicate that auto-SCT does not benefit patients with mantle cell lymphoma who achieve undetectable MRD after induction therapy,” summarized Dr. Fenske. “However, longer follow-up is needed to confirm these findings.”

Medical writing support was provided by Robert van den Heuvel.

Author

Teresa Sellinger

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REFERENCES & ADDITIONAL READING

Fenske T, et al. Lack of benefit of autologous hematopoietic cell transplantation (auto-HCT) in mantle cell lymphoma (MCL) patients in first complete remission (CR) with undetectable minimal residual disease (uMRD): initial report from the ECOG-ACRIN EA4151 phase 3 randomized trial. Late-breaking Abstract 6, 66^th ASH Annual Meeting, 7–10 December 2024, San Diego, CA, US.