Utility of Measurable Residual Disease (MRD) Assessment in Mantle Cell Lymphoma

• Published in: Current treatment options in oncology 2023-08, Vol.24 (8), p.929-947
• Main Authors: Wu, Simon, Blombery, Piers, Westerman, David, Tam, Constantine S.
• Format: Article
• Language: English
• Subjects: Adult; Blood cancer; Clinical trials; Heavy chains; Humans; Immunoglobulins; Immunoproliferative diseases; Lymphocytes; Lymphoma; Lymphoma, Mantle-Cell - diagnosis; Lymphoma, Mantle-Cell - genetics; Lymphoma, Mantle-Cell - therapy; Mantle cell lymphoma; Medicine; Medicine & Public Health; Neoplasm Recurrence, Local - genetics; Neoplasm, Residual - diagnosis; Neoplasm, Residual - genetics; Next-generation sequencing; Oncology; Polymerase chain reaction; Prognosis; Remission; Topical Collection on Lymphoma; Translocation, Genetic
• ISSN: 1527-2729; 1534-6277; 1534-5277
• DOI: 10.1007/s11864-023-01102-2

Opinion statement Mantle cell lymphoma (MCL) treatment advances have significantly improved disease-free remission, with greater focus in clinical trials being placed on measurable residual disease (MRD) as a marker of subclinical disease assessment. While this concept is used extensively in other haematological neoplasms, there is yet to be a consensus on the threshold for MRD in MCL that demonstrates prognostic and therapeutic significance, and in this context has yet to reach routine clinical practice. The historical long-term method for MCL MRD assessment has been real-time quantitative polymerase chain reaction (PCR), targeting the clonal immunoglobulin heavy locus (IGH) rearrangement or the IGH:: CCND1 translocation rearrangement. A significant problem at present relates to identifying alternative assays for patients who do not have a suitable molecular target by this method. This article reviews existing techniques used in MRD assessment for MCL and describes novel methods which may overcome existing limitations, including next-generation sequencing modalities. The use of circulating tumour DNA is explored, with techniques such as CAPP-Seq and PhasED-Seq demonstrating promise in B-lymphoproliferative disorders, though application in MCL requires further study. The other aspect of practice using MRD is identifying therapeutic options which can address a subclinical molecular relapse. Developing suitable interventions that can alter the disease trajectory based on longitudinal MRD kinetics are needed to justify its incorporation into standard care.