Spurgeon Stephen E, Till Brian G, Martin Peter, Goy Andre H, Dreyling Martin P, Gopal Ajay K, LeBlanc Michael, Leonard John P, Friedberg Jonathan W, Baizer Lawrence, Little Richard F, Kahl Brad S, Smith Mitchell R
Affiliations of authors: Division of Hematology and Medical Oncology, Oregon Health and Science (OHSU) University Knight Cancer Institute, Portland, OR (SES); Clinical Research Division, Fred Hutchinson Cancer Research Center/ Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA (BGT, AKG); Department of Medicine, Weill Cornell Medicine, New York, NY (PM, JPL); John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ (AHG); Department of Medicine III, Klinikum der Universität München, Campus Grosshadern, Munich, Germany (MPD); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (ML); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Coordinating Center for Clinical Trials, National Cancer Institute, National Institutes of Health, Bethesda, MD (LB); HIV and AIDS Malignancy Branch, Center for Cancer Research, and Clinical Investigations Branch, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (RFL); Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH (MRS).
J Natl Cancer Inst. 2016 Dec 31;109(1). doi: 10.1093/jnci/djw263. Print 2017 Jan.
Mantle cell lymphoma (MCL) comprises around 6% of all non-Hodgkin's lymphoma (NHL) diagnoses. In younger patients, age less than 60 to 65 years, aggressive induction often followed by consolidation with autologous stem cell transplant has suggested improved outcomes in this population. Less intensive therapies in older patients often followed by maintenance have been studied or are under active investigation. However, despite recent advances, MCL remains incurable, with a median overall survival of around five years. Patients with high-risk disease have particularly poor outcomes. Treatment varies widely across institutions, and to date no randomized trials comparing intensive vs less intensive approaches have been reported. Although recent data have highlighted the heterogeneity of MCL outcomes, patient assessment for treatment selection has largely been driven by patient age with little regard to fitness, disease biology, or disease risk. One critical advance is the finding that minimal residual disease status (MRD) after induction correlates with long-term outcomes. As such, its use as a potential end point could inform clinical trial design. In order to more rapidly improve the outcomes of MCL patients, clinical trials are needed that prospectively stratify patients on the basis of MCL biology and disease risk, incorporate novel agents, and use MRD to guide the need for additional therapy.
套细胞淋巴瘤（MCL）约占所有非霍奇金淋巴瘤（NHL）诊断病例的6%。在年龄小于60至65岁的年轻患者中，积极诱导治疗后常继以自体干细胞移植巩固治疗，这表明该人群的预后有所改善。对老年患者采用强度较低的治疗并常继以维持治疗的方案已得到研究或正在积极探索中。然而，尽管最近取得了进展，MCL仍然无法治愈，总体中位生存期约为五年。高危疾病患者的预后尤其差。各机构的治疗方法差异很大，迄今为止，尚未有比较强化治疗与低强度治疗方法的随机试验报告。尽管最近的数据突出了MCL预后的异质性，但在选择治疗方案时，对患者的评估很大程度上是由患者年龄驱动的，而很少考虑身体状况、疾病生物学特性或疾病风险。一项关键进展是发现诱导治疗后的微小残留病状态（MRD）与长期预后相关。因此，将其用作潜在的终点指标可为临床试验设计提供参考。为了更快地改善MCL患者的预后，需要开展临床试验，根据MCL生物学特性和疾病风险对患者进行前瞻性分层，纳入新型药物，并使用MRD来指导是否需要额外治疗。
