Despite the recent substantial improvement of clinical outcome in Mantle cell lymphoma (MCL), resistance to immunochemotherapy and common relapses are challenges for long-term tumor control.
The assessment of Minimal Residual Disease (MRD) by Real-Time Quantitative Polymerase Chain Reaction (RQ-PCR) has emerged as a widely feasible and standardized tool for direct assessment of therapy-induced reduction of tumor burden and regrowth after cytotoxic treatment in MCL, with much improved sensitivity compared with conventional staging procedures. Several studies have shown that intensification of initial treatment, which has resulted in improved clinical outcome, is immediately reflected in higher molecular remission rates; they have also shown that high-dose consolidation might not be able to compensate for less intensive induction regimens. Persistence or reappearance of MRD in clinical remission proved to be highly predictive for early clinical relapse associated with shorter overall survival. Therefore, the integration of MRD assessment into clinical response criteria could result in a more specific and potentially earlier end point for treatment efficacy. The aim of our project is to evaluate the MRD remission rate induced by different immunochemotherapy regimens in MCL patients, treated at our institution. MRD assessment will be performed in different time points: at baseline, during/after the treatment and during follow up for 24 months every 6 months.
During and after treatment, the detection and quantification of MRD by RQ-PCR offers the possibility of investigating the effect of different treatment strategies on tumor burden and detecting residual tumor cells with higher sensitivity compared to imaging assessment. Currently, monitoring of treatment response in MCL is according to Lugano classification's criteria including the [18F]fluorodeoxyglucose-PET(18F-FDG-PET)/computed tomography. However, the imaging techniques may not be sensitive enough to accurately assess response particularly in light of new targeted therapies with increasing remission rates. The evaluation of MRD become as a challenging tool for assessing the response to treatment in MCL on a highly sensitive level. Futhermore, in our project we attempt to evaluate the predictive role of MRD in patients obtaining a complete response according to Lugano classification's criteria including the [18F]fluorodeoxyglucose-PET(18F-FDG-PET)/computed tomography.