Dr. Rule on Patients With p53-Mutated MCL

Simon Rule, MD, PhD, professor of hematology at Plymouth University Medical School, United Kingdom, discusses treatment approaches for patients with p53-mutated mantle cell lymphoma (MCL).

Patients who harbor these mutations typically have the worst outcomes, Rule says. The Nordic Group conducted a study looking at young, fit patients with MCL who had p53 mutations and were being treated with standard high-dose cytarabine and receiving an autograft. The median overall survival for this subset of patients was less than 2 years.

BTK inhibitors have become the standard of care for relapsed/refractory patients, but those with p53 mutations do not derive much benefit from them, he adds. These patients usually present with highly proliferative disease, so they have trouble getting into remission. Rule says his approach for these patients is to do an allogeneic stem cell transplant (ASCT).

Just because there are encouraging, newer agents on the market, physicians should not forget the traditional strategies that are still effective, Rule notes. An upfront ASCT offers a potential cure for these patients.

He adds that a study conducted by investigators from the United Kingdom showed an 80% survival at 5 years in patients with MCL who had upfront allografting. Although the study’s findings do not challenge conventional treatment—autologous stem cell transplant—it provides good evidence that it’s a safe thing to do upfront in this patient population.