Dr. Elhassadi Discusses the Outlook of Patients With p53-Mutated MCL

Ezzat Elhassadi, MD, consultant hematologist, Hematology Services, University Hospital Waterford, discusses the outlook of patients with p53-mutated mantle cell lymphoma (MCL).

Patients need to have their p53 protein intact in order to benefit from chemoimmunotherapy, the frontline standard in MCL, Elhassadi says. Having a mutation in p53 likely means patients won’t benefit from chemotherapy. Chemotherapy may initially debulk their disease, but patients will quickly relapse. That’s why these patients have a poor survival compared with the majority of patients with MCL.

The selective advantage of resistance clones—hitting the normal hematopoietic cells—allows expansion of resistance clones, Elhassadi adds. This in part explains why using targeted therapy as a second-line treatment will not work as effectively as in the frontline setting. Since there are data that suggest patients with p53 mutations won’t benefit from single-agent ibrutinib (Imbruvica), these patients likely need a combination approach upfront.