Predictive value of minimal residual disease status after induction for efficacy of rituximab maintenance in elderly MCL patients

The outcomes of older (60 year or above) patients with mantle cell lymphoma (MCL) has improved by the introduction of immunochemotherapy followed by rituximab (R) maintenance. Assessment of minimal residual disease (MRD) status is a promising tool for individualized treatment decisions. Long-term follow-up of the European MCL Elderly trial found that R maintenance was highly effective in patients who were MRD-negative at the end of induction, by prolonging progression-free and overall survival. R maintenance was less effective in patient who were MRD-positive at the end of induction. The authors conclude that in MRD-negative patients treatment should not be de-escalated, while more effective consolidation strategies should be explored in MRD-positive patients.