In mantle cell lymphoma (MCL), minimal residual disease (MRD) analysis is a well-known prediction method. In the first prospective thorough analysis of various techniques, molecular markers, and tissues (peripheral blood [PB] and bone marrow [BM]), taken at clearly defined time points, researchers sought to describe MRD results from the Fondazione Italiana Linfomi phase 3 MCL0208 prospective clinical trial assessing lenalidomide (LEN) maintenance vs. observation after autologous stem cell transplantation (ASCT).
A molecular marker was found in 250 (83%) of the 300 individuals that were recruited, allowing them to examine 234 people and 4,351 analytical results from 10 time periods. High rates of molecular remission were brought on by ASCT (91% in the PB and 83% in the BM, as determined by quantitative real-time polymerase chain reaction [RQ-PCR]). Nevertheless, the proportion of patients in both groups who experienced durable clinical and molecular remission declined over time (down to 30% at 36 months). Early progression and long-term prognosis were predicted by MRD, especially starting at 6 months following ASCT (6-month time to progression [TTP] hazard ratio [HR], 3.83; P<.001). RQ-PCR was more dependable and performed better in single-timepoint analysis than PB, but nested PCR proved more suitable for a wider patient population (234 vs. 176).
To enhance the performance of MRD, they created a time-varying kinetic model based on routinely updated MRD results and the MIPI (Mantle Cell Lymphoma International Prognostic Index), which demonstrated an area under the ROC (Receiver Operating Characteristic) curve (AUROC) of up to 0.87 using BM. The performance of PB, when analyzed using kinetics, was equivalent to BM, with a notable AUROC of up to 0.81. MRD works well with models that continuously adjust patient risk since it is a potent predictor of MCL during its natural cycle.