Dr. Epstein-Peterson on Disease Observation and TP53 Mutations in MCL

Zachary Epstein-Peterson, MD, attending physician, Memorial Sloan Kettering Cancer Center, discusses important updates in mantle cell lymphoma (MCL) treatment, including the safety and feasibility of disease observation in patients with indolent MCL and the treatment of patients with TP53-mutated MCL.

Disease observation is safe in patients with indolent MCL who present with less aggressive or limited-stage disease, Epstein-Peterson says. Some patients can be observed for months or years after their initial MCL diagnosis without negative effects on their disease outcomes, Epstein-Peterson notes.

One category of patients in which observation is a safe strategy are those who have non-nodal leukemic MCL or MCL with minimal nodes that is predominantly in the spleen or circulating in the bloodstream, Epstein-Peterson explains. Another group of patients with MCL who can be safely observed are those with asymptomatic and indolent gastrointestinal (GI) tract disease that is found incidentally, such as through a routine colonoscopy, Epstein-Peterson says. The third group of patients in which MCL observation is safe, who are less common but still seen in the clinic, are those with predominantly nodal disease who may also have some GI tract disease and a low Ki67 proliferation index, but who do not have non-nodal leukemic disease and have a low disease burden, Epstein-Peterson emphasizes.

Further research has demonstrated the importance of considering patients' TP53 mutation status when choosing frontline treatment strategies if observation is not appropriate, Epstein-Peterson says. The Nordic MCL2 (ISRCTN 87866680) and phase 2 Nordic MCL3 (NCT00514475) trials showed that patients with MCL with TP53 aberrations who received intensive cytarabine-based chemoimmunotherapy followed by high-dose therapy and autologous stem cell rescue had shorter lengths of progression-free survival and overall survival than those without TP53 mutations, Epstein-Peterson emphasizes. These findings indicate the importance of enrolling patients with TP53-mutant MCL to clinical trials whenever possible, Epstein-Peterson concludes.