In this video courtesy of VJHemOnc, Jonathon B. Cohen, MD, MS, co-director of the lymphoma program and medical director of infusion services at Winship Cancer Institute of Emory University in Atlanta, outlines the next questions in mantle cell lymphoma.

Following is a transcript of his remarks:

The most immediate next steps, in my opinion, with mantle cell lymphoma are two-fold. The first is trying to better identify which type of therapy patients should receive in the frontline setting. So do all patients, for example, require a stem cell transplant just because they’re able to receive one? For the past 15 years or so, based on a fairly old randomized trial, we’ve been offering stem cell transplantation and first complete remission for most patients who are fit with mantle cell lymphoma. But there are now studies ongoing using modern regiments, trying to identify whether or not this is something that is still required. So that’s something that we hope to learn in the next couple of years.

Along those lines, we’re learning more about minimal residual disease and its role in the management of patients with mantle cell lymphoma. There are commercially available assays to help determine whether or not somebody is MRD [minimal residual disease] positive or negative. And while we recognize that being MRD negative is preferable to being MRD positive, I would say it still is not clear how to act on those data. That is if you have a patient who is MRD negative after their induction regimen, outside of the setting of a clinical trial, I would still strongly consider them for a stem cell transplant. And similarly, if you have somebody who is in radiographic complete remission, but still is MRD positive, it’s unclear what steps need to be taken at that point in order to improve those outcomes.

In the relapse setting, I think it also is going to be interesting over the next year or so to better identify who are the right patients to proceed with car T cell therapy, and when is the right time. Right now, in most cases for patients who are experiencing a first relapse, we’ve recommended a BTK [Bruton’s tyrosine kinase] inhibitor based on results of prior studies indicating that those agents are most effective when administered early in the course of treatment. But as we now are investigating BTK inhibitors earlier in the course of treatment and even in the frontline setting, and where we don’t have quite as many promising therapies in the relapse setting beyond BTK inhibitors, one question is when to offer CAR [chimeric antigen receptor] T-cell therapy to patients. And I suspect that that also is going to be something that is very patient-specific based on the disease behavior, as well as availability of a center offering CAR T-cell therapy to those patients.

These are things that hopefully over the next five to 10 years we’ll learn more about it, and have a much better standardized pathway.

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    Greg Laub joined MedPage Today in 2005 as Production Manager and led the launch of the video department in 2007. He is currently responsible for the website’s video production. Follow

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